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<br />STATE <br />COMPENSATION <br />INSURANCE <br />I=UND <br /> <br />-J... / ).)4 <br />d-,OD ./ <br /> <br />A~ <br /> <br />IN REPLY REFER TO: <br /> <br />APRIL 27, 2004 <br /> <br />SANTA ANA POLICE DEPARTMENT <br />ATTN BRIAN SHELDON <br />60 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702-6956 <br /> <br />CERTIFICATE OF WORKERS' <br /> <br />~---------------------- <br /> <br />COMPENSATION INSURANCE <br /> <br />---------------------- <br /> <br />CANCELLATION NOTICE <br /> <br />------------------- <br /> <br />RE: CERTIFICATE DATED OCTOBER 1, 2003 <br /> <br />THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER <br />NAMED BELOW HAS BEEN CANCELLED EFFECTIVE JUNE 1, 2004 AT <br />12:01 A.M. <br /> <br />IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE <br />CONTACT THE EMPLOYER NAMED BELOW <br /> <br />EMPLOYER: <br /> <br />THE OMEGA GROUP, INC <br />5160 CARROLL CANYON RD FL 1 <br />SAN DIEGO, CA 92121 <br />POLICY 1302649-03 <br /> <br />CUSTOMER SERVICE REPRESENTATIVE <br />CUSTOMER SERVICE CENTER <br />(877) 405-4545 <br /> <br />~e_~ <br />7 <br /> <br />1275 Market Street . San Francisco. CA 94103-1410 <br />Mailing Address: P.O. Box 420807' San Francisco, CA 94142-0807 <br /> <br />selF 19102 <br />