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STATE OF CALIFORNIA Edmund G. Brown Jr., Governor <br />DEPARTMENT OF INDUSTRIAL RELATIONS 0 <br />V ST", <br />OFFICE OF SELF-INSURANCE PLANS <br />11050 Olson Drive, Suite 230 ig <br />Rancho Cordova,CA 95670 <br />Phone No. (916) 464-7000 <br />FAX (916) 464-7007 <br />OF SELF-INSURANCE OF WORKERS' COMPENSATION <br />TO WHOM IT MAY CONCERN: <br />This certifies that Certificate of Consent to Self -Insure No. 0566 was issued by the Director of Industrial Relations to: <br />The Salvation Army <br />under the provisions of Section 3700, Labor Code of California with an effective date of November 15, 1933. The <br />certificate is currently in full force and effective. <br />Dated at Sacramento, California <br />This day the 20th of April 2017 <br />Lyn Asio Booz, Chief <br />ORIG: Craig Nicles <br />Director Of Claims Management <br />The Salvation Army <br />180 East Ocean Boulevard, loth Floor <br />Long Beach, Ca 90802 <br />�}r�, R[ekMxnegnnatDMs1an <br />y REVAEWED&/NPROV<D BY: <br />An '' a�wr <br />A,-----M Risk Manager nt Analyst <br />