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SP <br />CERTHOLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA 94142,,»0807 A -�00-� <br />"L."QM��NSATI'ON <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INS� <br />ISSUE DATE: 09-01-2003 GROUP: <br />POLICY NUMBER:-.'.'. 07763i$-3003 <br />CERTIFICATE ID:. 92 <br />CERTIFICATE EXPIRES: 09-01-2004 <br />09-01-2003/09-01-2004 <br />CITY OF SANTA ANA = Sp <br />ATTN JOHN MALONEY,, <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br />This intocertify that we have issued a valid Workers' Compensation insurance policy in a form: approved: by the <br />California laurance Commissioner to the employer named below for thepolicy; period -indicated. ._ <br />This policy is notsubject 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 cance11a4 prior, to'i1ssi�npiration. <br />This certificate of insurance is not an insurance policy and .does not amenx, Extend `or;after, the' cover44.e.' 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 Sssued or may pertain, tho iftsurance afforded by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. <br />NIL <br />AUTHORIZED REPRESENTATIVE PRESIDENT t ; <br />. EMPLOYER''S` LIABILITY LIMIT INCLUDING DEFENSE COSTS:: $1,000,000.00 PER EN, <br />ENDORSEMENT N2065 ENTITLED cERTiF.ICATE HOLDER'Sr'NOTICE EFPECTIVE 09-01-2003,,TS ATTACHE0,70 AND <br />'FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />APFRO v L� ,°, , 1 FORT✓, <br />LEGAL NAME ` <br />