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CERTHOLDER COPY <br /> Sc <br /> r <br /> CCMPrN5AT1QN P.O. BOX 8192, PLEASANTON, CA 94588 <br /> INSURANCE <br /> CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 07-03-2025 GROUP: <br /> POLICY NUMBER: 9362729-2025 <br /> CERTIFICATE ID: 5 <br /> CERTIFICATE EXPIRES: 07-03-2026 <br /> 07-03-2025/07-03-2026 <br /> CITY OF SANTA ANA SC <br /> ATTN: PUBLIC WORKS AGENCY <br /> 20 CIVIC CENTER PLZ # M-11 <br /> SANTA ANA CA 92701-4058 <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 except upon 10 days advance written notice to the employer. <br /> We will also give you 10 days advance notice should this 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 policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br /> afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br /> Authorized Representative President and CEO <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2025-07-03 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: <br /> CITY OF SANTA ANA <br /> ENDORSEMENT #1651 - SCOTT HUNTER, P - EXCLUDED. <br /> ENDORSEMENT #1651 - HEIDI HUNTER, S,T - EXCLUDED. <br /> EMPLOYER <br /> HILLSBOROUGH FENCE COMPANY DBA: HILLSBOROUGH <br /> FENCE COMPANY <br /> PO BOX 1272 <br /> LA MIRADA CA 90637 <br /> [SLG,CN] <br /> 1REV,7-2014} PRINTED 09-04-2025 <br />