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CERTIFICATE HOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUN DICERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />SEPTEMBER 24, 2003 GROUP: 000488 <br />POLICY NUMBER: 562-2003 <br />CERTIFICATE ID: 5 <br />CERTIFICATE EXPIRES: 04-01-2004 <br />04-01-2003/04-01-2004 <br />CITY OF SANTA ANA <br />COMM. DEVELOPMENT AGENCY M-25 <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Workers 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 theFundexcept upon 10: days advance written notice to the employer. <br />We will alsogive 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 after the coverage afforded by the <br />policies listed herein. Notwithstanding any requirement, term or condition R 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 ftEPRESENTATM: <br />PRESIDENT <br />u <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br />EMPLOYER <br />HUMAN OPTIONS <br />PO BOX 53745 <br />IRVINE CA 92619 <br />APPROVED AS TO FORM <br />L u a heedy <br />Deputy City Att rney <br />SCIF 10262E rEPF-UI: BO 1 <br />