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/"t— cLvUi -LiW./—. <br />NOV 07, 2002 11:25 AM FROM: 7149971994 PAGE 2 <br />CERTIFICATE HOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />NOVEMBER 7, 2002 GROUP: 000488 <br />POLICY NUMBER: 679-2002 <br />CERTIFICATE ID: 2 <br />CERTIFICATE EXPIRES: 08-15-2003 <br />08-15-2002/08-15-2003 <br />CITY OF SANTA ANA COMMUNITY <br />DEVELOPMENT AGENCY M-25 <br />P.O. BOX 1988 <br />SANTA ANA, CA 92702-1988 <br />This is to certify that we have issued a valid Worker's Compensation insurance Policy in a form approved by the California <br />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 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 normal expiration. <br />This certificate of insurance is not an insurance pclicy and does not amend, extend or alter the coverage afforded by the <br />policles listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br />described herein is subject to all the terns, exclusions, and conditions, of such policies. <br />7— <br />AUTHORIZED REPRESENTATIVE PRES DENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-15-2002 IS <br />ATTACHED TO AND FORMS A PART OF THTS POLICY. <br />,.r1cUV�ll AS lv 1-01— <br />aura S. ecdY <br />Deputy City Attorney <br />EMPLOYER <br />WLSEPLACE, A CA CORP <br />1411 N BROADt9AY <br />