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CERTHOLDER COPY <br />P.O, BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-01-2010 <br />CITY OF SANTA ANA SG <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br />GROUP: 000290 <br />POLICY NUMBER: 0002003-2010 <br />CERTIFICATE ID: 19 <br />CERTIFICATE EXPIRES: 04-01-2011 <br />04-01-2010104-01-2011 <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 30 days advance written notice to the employer. <br />We will also give you 30 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 />thormed Representative Interim President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 111600 - WHITECOTTON, ROBERT, P,S T - EXCLUDED. <br />ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />MASTER LANDSCAPE & MAINTENANCE, INC. SG <br />10171 NORTHAMPTON AVE <br />WESTMINSTER CA 92683 <br />[B 1 E,SP] <br />SG <br />PRINTED : 07-13-2010 <br />(REV.1-2010)