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e reauxni� x Y <br />•YIkfNiOPIttYE• <br />A Public Servlce Agency <br />CERTIFICATE OF SELF-INSURANCE <br />This is to certify that: <br />,_.. ._.. .. _. The -Salvation- Army. - .. .. .. .. .. __ . <br />_. <br />-� - NAME OF BELF•INSUREfl <br />30840 Hawthorne Boulevard, Rancho Palos Verde, California 90275 <br />�. _e. �_w__._.. _„............._.._,- .. <br />naoREss, a rr, srnrE, nr <br />has been approved as a Self -Insurer under the California Compulsory Financial Responsibility <br />Law and assigned Self -Insurance #, 202 pursuant to Section 16053 of the California <br />Uahicle Code for the period _ August 19, 2019 through August 18, 2020 <br />MANAGER • <br />Financial Responsibility Unit <br />Department of Motor Vehicles <br />REVIEWED & APPROVED <br />By Risk MANACEEMEw DIVISION <br />SR 27 (REV. 101E10) UN Ot'�C 0 �(]9(3 <br />_. V. u. 9 <br />FRANCINE R, VIL AREAL <br />