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CERTHOLDER COPY <br />115 <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSUPt A,NCE <br />FUND D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 05-30-2009 GROUP: <br />POLICY NUMBER: 0355209-2009 <br />CERTIFICATE ID: 117 <br />CERTIFICATE EXPIRES: 05-30-2010 <br />05-30-2009/05-30-2010 <br />CITY OF SANTA ANA SP <br />ATTN CARLA THOMPKINS <br />PO BOX 1988 M-25 <br />SANTA ANA CA 92702 <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 />THORIZEO REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05-30-1990 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />ORANGE COUNTY FAIR HOUSING COUNCIL (A SP <br />NON-PROFIT CORP.) <br />201 S BROADWAY <br />SANTA ANA CA 92701 <br />M0408 <br />1REv.rasl PRINTED : 04-17-2009 <br />