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<br />SG <br /> <br />CERTHOLDER COPY <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807. SAN FRANCISCO.CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 11-01-2005 <br /> <br />GROUP, <br />POLICY NUMBER: 0539598-2005 <br />CERTIFICATE ID, 199 <br />CERTIFICATE EXPIRES: 09-01-2006 <br />08-01-2005/08-01-2006 <br /> <br />CITY OF SANTA ANA <br />CLERK OF CITY COUNCIL <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />SG <br /> <br />u06:12-1055 <br /> <br />This is to certify that we have issued II 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 /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <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 the terms, exclusions, and conditions. of such policy. <br /> <br />~ <br /> <br />J~c <br /> <br />~ <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br /> <br />EMPLOYER'S LIA6ILITY LIMIT INCLUDING DEFENSE COSTS: $1.000.000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-1991 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />\;;'~, .,' .:,) AS TO FORM <br /> <br /> <br />-~':tlSLceY <br />j., ..,,';t(.:,l, City Attoc,-cy <br /> <br /> <br />9EINHAKER PLANNING & DEVELOPMENT AND SERVICES <br />INC. (PARTNER) AND NEAL A. IRWIN OF CALIFORNIA <br />INC (PARTNER) AND LAVALLE CONSULTANTS INC. <br />(PARTNERS) D9A: 161 GROUP <br />18401 VON KARMAN AVE STE 110 <br />IRVINE CA 92612 <br /> <br />(AEV,2.05J <br /> <br />PRINTED <br /> <br />[RLI.CN] <br />11-01-2005 <br />