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SD <br /> <br />CERTHOEDER COPY <br /> <br />STATE <br /> P.O. BOx 807; SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION : ~ :: <br />IN SUIRANCE; : ~ <br /> <br />I=UND CERTIFICATE OF WORKERS" COMPENSATION :INSURANCE <br /> <br />ISSUE DATE: 04-01-2003 <br /> <br /> C1TY OF SANTA ANA, <br />p O BOX t988 M;28 <br /> 20 CIVIC CENTER PLAZA <br /> SANTA ANA CA 92701 <br /> <br /> : GROUP: <br /> ; : POLICY NUMBER: 1608608-2003 <br /> CERTIFICATE ID: 1 <br /> CERTIFICATE EXPIRES: 04-01-2004 <br /> 04-0'1--2003/04-0'1-2004 <br /> <br />RISK MANAGEMENT DIVISION :: JOB: ATTN: ~EFF STEVENS, RISK <br /> EM! L0N BUENAFE <br /> <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 nameci below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon lodays' advance written notice to the employer. <br /> <br />We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document <br />with respect to which this certificate of insurance maybe issued or may pertain, the insurance afforded by the <br />policies ciescribed herein is subject to all the terms, exclusions an0 conditions of such policies. <br /> <br />AUTHORIZED REPRESENTATIVE PRES DENT <br /> <br />EMPLOYER/S LZABZLITY LZMZ:T ZNCLUDZNG DEFENSE COSTS: $1,000;000.O0 PER OCCURRENCE. <br /> <br />EMPLOYER <br /> <br />KEY MOVES <br />1308 EL NI. DO DR <br />FALLBROOK C'A 92028 <br /> <br />LEGAL NAME <br /> <br />UOHN B CLODZG APC AND/OR <br />CLODZG, UOI-IB B <br /> <br />PRINTED: <br /> <br />03-17-2003 <br /> P040B <br /> <br /> <br />