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CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 12-01-2008 GROUP: <br />POLICY NUMBER: 1675014-2008 <br />n I i ~~~~ ~- ~ ~~ CERTIFICATE ID: 1 <br />ICJ CERTIFICATE EXPIRES: 12-01-2008 <br />~- Z ~i03 17 ~ 12-01-2008/12-Ot-2008 <br />CITY OF SANTA ANA SP <br />BO CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4060 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy 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 to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all `thne~ter_ms,~exclu~sion~s,-and~co/nditions, of such policy. <br />THORIZED REPRESENTATI CC..II PRESIDENT <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND ANO WIFE EMPLOYER; <br />CALIFORNIAWORKERS NCOMPENSATIONSBENEFITSONEMPLOVEES EXCLUDED~NDEROCALIFORNIAAWORKERSG' <br />COMPENSATION LAW. <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: f1,000,000 PER OCCURRENCE <br />Jr~ <br />(' / t <br />EMPLOYER <br />GRUVER, ERIC PH D SP <br />17772 17TH ST STE 106 <br />TUSTIN CA 92780 <br />PRINTED 11-17-2008 <br />SP V <br />M0408 <br />IREV.2-051 <br />