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., SG <br />THOLDERCOPY <br />w7 T ATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />I N S U RA NICE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08-01-2003 <br />CITY OF SANTA ANA <br />COMMUNITY<DEVELOPMENT _AGENCY <br />P.O. BOX 1988 <br />SANTA ANA CA 92701 <br />GROUP: <br />POLICY NUMBER: 0675401-2003 <br />CERTIFICATE ID: 14 <br />CERTIFICATE EXPIRES: 08-01-2004 <br />08-01-2003/08-01-2004 <br />SG <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />Caiifornia Insurance Commissioner to the employer named beiow for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. <br />We will also give you 30 days' advance notice should this policy be cancelled prior to its normalexpiration. <br />This certificate of insuranceis 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 may be issued or may pertain, the insurance afforded by; the <br />policies described herein is subject to all: the terms, exclusions and conditions of such policies. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S 'LIABILITY LIMIT INCLUDING DEFENSE COSTS'. $1,000,000_00 PER OCCURRENCE. <br />ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-2003 IS ATTACHED TO AND <br />-FORMS A PART OF THIS POLICY. <br />ApPR�VFi= <br />A,1 i f) v o <br />5�4"Iy <br />T�„AI101roc` <br />EMPLOYER <br />.LEGAL NAME <br />< SHARE OUR SELVES ( SHARE OUR SELVES CORPORATION <br />1550 SUPERIOR AVE i. (A NON-PROFIT r CORP.) <br />COSTA MESA CA 92627 <br />EV.3-03 07-16-2003. <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND <br />