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CERTHOLDER COPY <br />at�x �aT sAry FRa1�ICIsa,cA;sa�42-aao� �1-003-07`� - 1 <br />y'tr <br />-W3 <br />* TA6A4OF. WORKERS' COMPENSATION'' INWRANCE <br />f$SUE tTE -"t6 91^200 GROUP: <br />POLICY NUMBER: "17x$'320-2003 <br />CERTIFICATE ID: is <br />CERFIiC 10 O1P7003f70-09-2004 <br />CITY of MANTA ANA+ s% <br />` g" <br />TAY M-25MEYEiQI98MUT <br />OR`sa;MWTdNYA ^. <br />92702 , <br />�. <br />• This Is to>certify ;d6af we have issued a valid Workers' Compensation insurance policy in a,form•;Appr4ved by"tie <br />Callfornm Insurance Commissioner to bo emordyer named below, for the policy period indicated. <br />This policy' is not subject to cancellation bk. ttte FuntS'except upon 10days' advanC§ written not# 'tp t4i® employer: ' <br />We will afs6 give'"you 10 bays' advance notice 0ould*5 policy be cancelled 'prior to, its tiprrnal' sspiratrod:` <br />�Thlas`oertificptol Insuran*Is not an insurance policy; does •not smand. extend or, ,#hervther coverage ef$orded <br />by the policies hst�ed harem: Notwithstanding **'regy#ement, term, or condition of any contract br.dther document, <br />with respect to which this cettiflcate �6t inita*atice rreij be.issued AS may pertain, the insurance afforded by the <br />"« PoG s; d9scri4ed heCQ is Ipject to all the terms, exgiyrions sNd• conditions of such poirciea. ^s <br />r <br />... .r,r�.,,ven nemesc�rrnnvo PRESIDENT <br />L. <br />s\ Yrv"�'Lu <br />4TH,ST <br />".CLUDE`:+D+E C05'I`S: <br />ffi1,000,000:00.0!R <br />OCCU[tRENCE: <br />- <br />---, <br />.. .. t <br />arc; ,x <br />A I ROVrij <br />J r.ur ti ,cedy <br />l iii411\ City :Nj rll`.`4 <br />t• <br />w'kir ' <br />