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SP <br />A C CEHfHOLDER COPY <br />STATE":P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-01-2004 GROUP: <br />POLICY NUMBER: 1234182-2004 <br />CERTIFICATE ID: 4 <br />CERTIFICATE EXPIRES: 01-01-2005 <br />01-01-2004/01-01-2005 <br />CITY OF SANTA ANA Sp JOB: ALL OPERATIONS <br />COMMUNITY<DEV. AGENCY M-25 ATTN: DORRIS <br />20 CIVIC CENTER PLAZA, PO BOX 1988 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a 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 />This policy is not subject to cancellation by the Fund except upon 10days' advance written notice to the employer. <br />We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of .insuranceis not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the polices 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 may °pertain, the insurance afforded by: the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. <br />Ae . <br />AUTHORIZED REPRESENTATIVE PRESIDENT' <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />i <br />EMPLOYER <br />..LEGAL NAME <br />SAINT JOSEPH BALLET COMPANY SAINT JOSEPH BALLET COMPANY <br />1810 N MAIN ST' ,' (A NON-PROFIT e CORP.) <br />SANTA ANA CA 92706 <br />k°=^v-r1 d>� 1 .�. ;,T�e �' .h" :.. . _ xtx: �> _ 12-12-2003, <br />