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POLICYHOLDER COPY <br />STATE <br />C '\.1 f -"~...., ,-. 1_,r-.. <br />L,-L =t...'J,,..~ <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />FUND <br />ISSUE DATE: 06-18-2024 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP : <br />CITY OF PLEASANTON <br />PO BOX 520 <br />PLEASANTON CA 94566-0802 <br />NA <br />POLICY NUMBER: 1291631-2024 <br />CERTIFICATE ID: 324 <br />CERTIFICATE EXPIRES: 07-01-2025 <br />07-01-2024/07 -01-2025 <br />This is to certify that we have issued a val id 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 nor mal expir at ion. <br />This certif icate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy l isted herein. Notwithstanding any requirement, ter m or condit ion of any contract or other document <br />with respect to which th is certi f icate 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 />~t!,q <br />Author i zed Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS ' NOTICE EFFECTIVE 07 -01-2024 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />ENDORSEMENT #2572 ENTITLED BLANKET WAIVER OF SUBROGATION EFFECTIVE <br />2024-07-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY <br />EMPLOYER <br />EDEN COUNCIL FOR HOPE AND OPPORTUNITY PROGRAM <br />A NON-PROFIT CORP. <br />22551 2ND ST STE 200 <br />HAYWARD CA 94541 <br />(REV .7 -2014) PRINTED <br />[JG3 ,CS) <br />06-18 -2024 <br />NA <br />Docusign Envelope ID: F53F1E05-ADA3-465D-BE20-156E055217E3