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<br />ISSUE DATE:
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<br />04-01-2004
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<br />P.O. BOX .807, SAN FRANCISCO,CA,.,,'94112%Ôap.7 , ,\'
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<br />CERTIFICATE OF WORKERS' COMPENSATION 'iNSURANCE :. é'
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<br />COMP ÈNS","1'10N
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<br />CITY OF SÁNTAANÀ-FINANCE &
<br />DEP,rOF 'BUILD I NG,AND SAFETY
<br />20 CIVIC CENTER PLAZA " , '
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<br />SANTA ANA CA 92702
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<br />This is to certify that we have issueda valid Workers' Compens~tfCH'\,irlsl;Jr~c~'p~lic{.in..i-form ,approved by the
<br />California-Insurance Commissioner to the employernaml9d ~e(o~..~p~",t~e:pÞ,.li:~y.:period j"di9a~ed.
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<br />This policy is not subject to cancellation by the Fund except upon 30 d.aýsr:'fI.~~a_~~e written '~orife to the employer.
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<br />We will also give you, 30 days' aØvan;ce notice should thispoliçy be càncerr~d ',Þ.rj~r tolts'normar'expiratjon.
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<br />This cøitìl~c~te_'Öf'_insllrarice is nqt an ín~~ur1nce pOlicy,anl dó'~s nÒ(:~rT1~rl1i."."éx.t~inèi)o¡"a:ltér, _the :-coverag'e afforded
<br />by the p_olîcies lis,ted heTe¡~:-'Notw¡thstançfing anYr:'E!_9,uirerrient. ,term, or .éon.dì-;iorr o:f "anycÇ)ntract oF":other docum~_nt
<br />with resp_~ct to which this certificate of:insurange 'm~y~b&:,¡ssued _ormay,:per:t~ln.:::the insúranC'e -afforded, by the ~ --
<br />policies d~scribed herein is subject to all tl;te terms. excl~siQns andcond¡tion's.o~ 's"uch PQ¡'icies. '
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<br />AUTHORIZED, REPRESEIlÍT A TIVE
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<br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:i: $(C)OO\~~.;;ØOI'ER'ÓCCURRENCE.
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<br />ENDORSEMENT #2065 ENTITLED CERTIFICATE IiOLOERS' N¡n;iC:;,E.,FFECTIVE O~C()I-2q,04 IS ATTÞ.-CHEDTO AND
<br />FORMS A PART OF THIS POLICY.' , ';",i ,>;
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<br />LIEBERT CASSIDY WHITMORE
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<br />LOS~~.,GELES C,.A 90045.,
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<br />.f'~:',:' ~';",>~,:}èlC;!,{~::;,íâ, PFÎ'N;Ei.'è~~>~~/2004
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<br />P0410
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