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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 />APRIL 30, 2003 GROUP: <br />POLICY NUMBER: 355209-2003 <br />CERTIFICATE ID: 117 <br />CERTIFICATE EXPIRES: 05-30-2004 <br />05-30-2003/05-30-2004 <br />CITY OF SANTA ANA <br />ATTN CARLA THOMPKINS <br />PO BOX 1988 M-25 <br />SANTA ANA CA 92702 <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 policybe 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 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 <br />Ait , e. t9� <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05-30-2003 IS <br />ATTACHED TO AND FORMS A PART OF THIS. POLICY_ <br />APPROVED AS TO FORM <br />744' 1z <br />aura h�efly <br />D*Pllty City Attorney, <br />EMPLOYER <br />ORANGE COUNTY FAIR HOUSING COUNCIL (A NON-PROFIT <br />CORP.) <br />201 S BROADWAY <br />SANTA ANA CA 92701 <br />SCIF 10262E rEPF-Ul: P91 <br />