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PR raXsk,7yel~vt~~eal_Estate_se 5/z6/2010x7 16:475Ahi7sPAQE 1/002y zFax1ServerM Ps <br /> CERTHOI.DER COPY' <br /> SD <br /> SPATE P.O. BOX 420807, SAN FRewCISCO,CA 94 1 42-0807 <br /> COMPENSATION <br /> INStJRANC6 <br /> ~U~~ CERtIFICATE OF WORKERS° COMPeNSATIOIW INSURANCE <br /> ISSUE DATE: 03-011-2010 GROUP: <br /> POLICY NUMBER: 11175997-2010 <br /> CERTIFICATE ID: S <br /> CERTIFICATE EXPIRE5:01-01-2011 <br /> 01-01-2010/01-01-2011 <br /> CITY OF SANTA ANA SO <br /> ATTN: MART A6UILAR <br /> 70 CIVIC CENTER.PLZ 3RD FL <br /> SANTA ANA CA 92701-40ba <br /> This Is to certify that we hale issued • valid Workers' Compensation insurance policy In a form approved by the <br /> Call}ornh Insurance Commissioner to the employer named below }or the Polley period indiemed. . <br /> This policy is not eubject to cancellation by tha Fund excapt upon 10 days advance written notloe to the eMD}oyer. <br /> Wa win also givo rou 10 dsys' advance notice should this policy be cancelled prior W Its normal exprrstlon <br /> This eartlfieab of insurance is not en insurance Polley and does not amend. extend or alter the coverage afforded <br /> by the policy listed herein Notwithstanding any reQuiremenL term or condition of any contract m other document <br /> with res?cot to which this certificate of insurance may be isswd or to which it may perta,n. the inaurarice <br /> afforded by Ilia policy described Ixrein it: subject, to all the terms, ezc;uslons, and conditions, of such policy. <br /> ` <br /> THORIZED REPRESENTATi PRESIDENT <br /> UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCWDES THE FOLLOYING: <br /> THOSE NAMED IN THE POLICY DECLARATIONS AS AN. INDIVIDUAL EMPLOYER DR A HUSBAND AND WIFE EMPLOYER; <br /> EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIA®[LITY [NSURANCE POLICY ALSO AFFORDING <br /> CALLFORNIA WORKERS' COI~ENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA YORKERS' <br /> CO/~ENSATION LAW. <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: Y1,000,000 PER pCCl1RRENCE. <br /> APpR~~D AS TO ~©RM <br /> LISA <br /> E <br /> STORCK <br /> Assistant City Attorney <br /> EMPLOYER <br /> INMIAN, HANNELDRE 84TH DBA: SKYLINE REAL ESTATE <br /> SERVICES <br /> Po cox 1t11s33 <br /> CDRONADO CA 97178 <br /> [JLD,CSJ <br /> <br /> tnEV.~-os1 PR[NTED 03-06-2010 <br /> <br />