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OwA- ZO&Z , 043 - It, <br />• Ci,F� . E HOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />APRIL 17, 2003 GROUP: <br />POLICY NUMBER: 1610814-2003 <br />CERTIFICATE ID: 18 <br />CERTIFICATE EXPIRES: 03-28-2004 <br />03-28-2003/03-28-2004 <br />CITY OF SANTA ANA-CDBG M-25 <br />ATTENTION: CARLA THOMPKINS <br />PO BOX 1988 M-25 <br />SANTA ANA CA 92705 <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 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 by the <br />policies 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 terms, exclusions, and conditions, of such policies. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br />EMPLOYER <br />WOMEN'S TRANSITIONAL LIVING CENTER, INC <br />PO BOX 6103 <br />ORANGE CA 92863 <br />trip imF,c <br />