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,•1 03 04:10p WIS— lace (7141542-3653 p. <br />CERTHOLDER COPY <br />STATE L O BOX 807, SAN FRANCISCO;CA 94142-0807 <br />-pr..IPE NSATION <br />t!SURANCE - <br />F UN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE' <br />5 DATE. 08-15-2003 GRWP '000488. - <br />POLICY NUMBER; `;,00006'19--2003 <br />CERTIFICATE tD ' 1 <br />CERTIFICATE EXPIRES:. 08-15-2004 <br />_. 08715-2003(b6-15-2004. <br />CITY OF SANTA ANA SP <br />HOUSING DEPARTMENT - M26 - <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 - - <br />..:.. <br />s to ce,:it, that we -,.a.e ssv9d a rai-d Workers' Compensation insurance pofiCY in a'fo'm approved by the <br />orne Insurance Commc:; Ie\ei to the employer named below for the policy period Indicated - <br />odic tit subject tc cancellat,on by the Fund except upon i0days. advance written notice. to the employer. <br />v.ilt aise iin you 10 days advance notice should this, policy be cancelled prior to Its. normal expiration. <br />t certificate of insurance is not an insurance Policy -'arid "does not amendreittend or alter the,coveraBe afforded <br />:he policies listed here,,,. !notwithstanding any requlrt,ment, term, Or CogditipR of any GQntraot or other document. <br />, respect to ,,filch this certificate of insurance may bg,'issued Or may petCain,,the'insurande .afforded by the <br />Jet oescnbeo herein is subject to all the terms, 4xclusions antl conditions of such policies; - <br />"HORIZED REPRESENTA"'d< PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTSt g1,000,Q00.6 <br />0 PER OCCURRENCE. <br />EMPLOYER J,E(iAl L�ItME <br />t <br />WISEPLACF, A -A CORP ,MISEPI�E` rA CA-CORP <br />141l N BROADWAY ,. <br />SANTA ANA CA 92706 <br />