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STATE . P.O. BOX 420807, SAN FRANCISCO, CA 9 4142 -00 0 7 <br />COMP6.NSATION <br />INSURANCrE .. .; <br />FUNiD CERTIFICATE OF WORKERS" COMPENSATION INSURANCE <br />.AUGUST 4, 2003:. POLICY NUMBER' 1696 %70 - 01 <br />'- CERTIFICATE EXPIRES: 6- 30 -04' <br />CITY OF -SANTA!ANA ', <br />'SAW ANA ' CA 92 <br />702 <br />This is to certify. that we have Issued a valid Workers' Compensation-i nsurance policy in a form approved by the California <br />Insurance Conim ssio6er'ia the employer r amee'belowforthe. policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. <br />We will also give you TEWdays ativ@ncq notice should this policy be cancelled prior to its normal expiration. <br />- <br />This certificate of, insuranc9 is not an insurance policy and does not amend, extend of "alter the coverage afforded by the <br />policies listed herein. Notwifhst8ndmg apy �"equlremert,_ term, or condition of.Anv contract or other document with <br />respect to' =which this certificafe of insurinde may be is §iied or may pertain, fhe` insurance afforded by the policies. <br />described herein -is subject to all the terms,'.explusions;and cdriditions of such policies. <br />AD• <br />_ e <br />ALI THOR IZiFDREPRESE NTATI VE% j PRESIDENT <br />MKOYER S LIAPli_10 LIMIT. INCL�IDSNG DEFENSE ' $TS: f1,000,000 PEk OCGUf ;kEhICE:.. <br />EMPL¢YER L <br />Ai <br />�sf I, .- <br />1 � <br />-, 1111 WAkE id` "gUE ` E a <br />s`RNTAi AN A c <br />i <br />