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.. C <br />~/'1TE P O. BOX 420807, SAN FRANCISCO, C,A 94142-0807 <br />COMPENSATION ' <br />INSIJRAN GE ' <br />~U N-~ CERTIFICATE QF, WORKERS' COMPENSATION INSURANCE <br />AUGUST 4, 2003. _ PoucvrvuMSER:1696570 - 03 <br />" ""' ~ CERTIFICATE EXPIRES:6-30-0'3 °-~- <br />r. <br />CITY qF SANTA =ANA <br />RD "bOX' d5'$8 <br />$AFlTA ANA CA 92702 <br />L _ ., ,~.w .: ,, ~. <br />This Is to Cerhfy~that we have issued a valid Workgrs' Gompensatiominsurance policy in a form approved by the California <br />Insurance Commissipner'totlie employ€r narfte?9 6eloW'for the policy period indicated. *'- ~ - ;-- <br />This policy Is not subject to cancellation by the Fund except upon ten days' advance written notice to the employee <br />We will also give you TEhk days' edvanc~ notice should this policy be cancelled prior to its normal expiration. <br />Thls ceitrfic~te of;insurance is not an insuraribe policy and does not amend, extend or alter the coverage afforded by the <br />pohcles listed herein. NotW~hstanding af~y 3egwrement, term, or condition ~of tiny contract or other document with <br />respect to'=whlChahis certificate of insurance may be. issued. or may pertain, the insurance afforded byahe poNcies-- ':, <br />described herelnas subject to all the termsjexeluslgns and cdnditions of such policies. <br />.._ :' _. <br />!i <br />~-- „~ <br />e <br />V"'"~' <br />`. AUTHORIZED'AEPR ESh'NTATIVE>- 4. PRESIDENT <br />", 'i:`MRtOYER'S LIAFII.ITY LIMIT ,INCLUDING DEFENSE 4'b$TS: f1.000,004 PEk OCCUfikEhICE`:. <br />_. , <br />._ ~ ,,, <br />k 7I _7_ _. <br />~: ,I <br />t.,,, : <br />~" ~~. <br />~s ;z <br />.nl~"x <br />t~ i ~/ ~ ~+~ 3, ~ " <br />#L ~ a / <br />i «* <br />i t,: . rc, ,%.F' : ,9 <br />'~ EMPf(~Y~R '~ ~ ~ `~' <br />~~ <br />+ s a ~ <br />S ~ ti ,: w, ~~'-v . k ~ T.rS, '~ .,, a,. <br />,ra ~'^' a t.~ fir` <br />a <br />THE 1;A~t8$DkAN~ ~gfiF~L~~ " ~' <br />,Y 1`11 WAKEtli~ld ~ ~a11E S~E~ E " .; ", <br />" <br />y <br />,. saNra AFdA, ~ °° <br />x. , <br />;., <br />t .. ION. ?,7n, ®(r'"„~~nr <br />