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STATE <br />~ t_ M t -"•-.-.. \..J1'. <br />r. ,; L = t... 'J :"" : <br />FUND <br />ISSUE DATE: 06-18-2024 <br />CITY OF PLEASANTON <br />PO BOX 520 <br />CERTHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP: <br />POLICY NUMBER: 1291631-2024 <br />CERTIFICATE ID: 324 <br />CERTIFICATE EXPIRES: 07-01-2025 <br />07-01-2024/07-01-2025 <br />NA <br />PLEASANTON CA 94566-0802 <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 nor mal expiration. <br />Th is certificate of insurance is not an insurance policy and does not amend . extend or alter the coverage afforded <br />by the poli cy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which th is certi ficate of insurance may be i ssued or to which it may pertain, the insurance <br />afforded by the policy described herein i s subject to all the terms, exclusions. and conditions, of such policy. <br />~ £:::/ L ..J/4:.,___, <br />Authori 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 />IREV.7 -2014) <br />[JG3 ,CSJ <br />PRINTED 06-18-2024 <br />NA <br />Docusign Envelope ID: F53F1E05-ADA3-465D-BE20-156E055217E3