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CERTHOLDER COPY <br />ISSUE DATE: 03-22-2011 <br />P.O. BOX 420607, SAN FRANCISCO,CA 94 1 42-080 7 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP: 000092 <br />POLICY NUMBER: 00 0087 8-20 10 <br />CERTIFICATE ID: 370 <br />CERTIFICATE EXPIRES: 01-01-2012 <br />ol-01-2o11io1-o1-2olz <br />THIS CERTIFICATE SUPERSEDES AND CORRECTS <br />CERTIFICATE ff 340 DATED 01-04-2011 <br />CITY OF SANTA ANA SCi <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund excepc upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance noTice should [his policy be cancelled prior to its normal expiration- <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the pglicy listed herein. Notwithstanding any requirement. term or Condition of any contract or other document <br />wi[ft respect to which this certificate of insurance msy be issued or to which it may pertain, the insurance <br />of fortled by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />l ? WyNC4 ?? <br />Authorized Representative President and CEO <br />EMPLOYERrS LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. <br />ENDORSEMENT (/1600 - ROGER FRANK PRES - EXCLUDED. <br />ENDORSEMENT //11600 - ALAN FRANK S,T - EXCLUDED. <br />ENDORSEMENT N2065 ENTITLED CERTSFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY- <br />ENDORSEMENT K2570 ENTITLED MAIVER OF SUBROGATION EFFECTIVE 2011-O1-p4 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: <br />CITY OF SANTA ANA <br />- _'- 'S ti ? i,? u? i Sh1??-- ? _ _ _ <br />r;? City A>'re?' .., <br />EMPLOYER <br />JOFNSON-FRANK & ASSOCIATES (A CORP) SG <br />5750 E HUNTER AVE <br />ANAHEIM CA 92807 <br />SG <br />[B1Q,SG1 <br />(RE'J. a-2010) PRINTED 03-22-2011