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<br />r <br /> <br />"----, <br />stATE <br />, COM"""SATION <br /> <br />FuÑë <br /> <br />œRTHO~DER COpy <br />\ ' <br /> <br />P'.O.80X 807, SAN Í"AANCfSCO,CA 94142-0$07 <br /> <br />CERTIFICA'l'EOFWORKERS'COMPENSA TIOI'Ji INSURANCE <br /> <br />ISSUE DATe: <br /> <br />03-01-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 1466943-2004 <br />CERTIFICATe 10: 14 <br />CERTIFICATE EXPIRes: Q3-01-2ooS <br />03"'01 w2004~".O1'2QO!1. <br /> <br />,J08: ASBESTOS CONSULTiNG: <br />SERVICES <br /> <br />THE CITY OF SANTA ANA <br />20 ClVIC.CENTER <br />SANTA ANA CA 927°1 <br /> <br /> <br />N-).oo,J..- 0'(, f <br />IJ - ~oo;}..':'()fø f-:-l <br /> <br />This is to certi1y that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />Califormà"~'fance Commissioner to the employer named below for lI1e i'olj~y period Indicated, <br /> <br />This policy is not subject to cancellation by the Fund/except upon 30 days' advãhce W1'Itten' not¡~ to the employer, <br /> <br />We will also give you30doVS'.adv¡mce notice should this POlicy be cancelled prior to its normal expiration, <br /> <br />This certificate~of;'ir\$Ur,¡qc<I¡$ net"" insùrance policy and does not ame~d, exle~d or alter the øoverage afforded <br />by the pollcies!!$ted herêin,'NQlwiths , ¡my requirement, term. or 6oriditio~ Of any co~lract or other document <br />will1 resþ..ØI to'wmøh lI1iscertificate qof\Ce'måyb.. issued or may pertain, the insurance offordeci by the <br />pOlicies desØril?ed herein is subject to jarms, "xcluSions and conditions Of such policies, <br /> <br />~ <br /> <br />jj~ t!. <br /> <br />~ <br /> <br />AUTHORIZED RePReSENT A TIVE <br /> <br />PRESIDENT <br /> <br />EMP~OYP'S LIABI~ITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br />$1,000,OOÐ,QO <br /> <br />OCCURRENCE, <br /> <br />EIllQORSEMÉNT . #2085' ENTITLED CERTIFICATEHlltDtRS' NOnCE EFFEctIVE 0i-01-2004 IS <br />FOIÚIS A PART OF THIS POLICY; <br /> <br /> <br /> <br /> <br />L.EGAL NAME <br /> <br /> <br />PRINTED: <br /> <br />. :' <br /> <br />. . <br /> <br />.. <br /> <br />, : <br /> <br />AND <br /> <br /> <br />PO408 <br />