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<br />A <br /> <br />.\ <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />IN REPLY REFER TO: <br /> <br />JANUARY 25, 2005 <br /> <br />CITY OF SANTA ANA <br />ATTN CITY ATTORNEY JOSEPH W FLETCHER <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br /> <br />CERTIFICATE OF WORKERS' <br /> <br />COMPENSATION INSURANCE <br /> <br />CANCELLATION/CONVERSION NOTICE <br /> <br />RE: CERTIFICATE DATED JANUARY 1, 2004 <br /> <br />THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE <br /> <br />POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY <br /> <br />EFFECTIVE JANUARY 1, 2005. <br />UNINTERRUPTED COVERAGE. <br /> <br />THE NEW POLICY WILL PROVIDE <br /> <br />YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER <br /> <br />THE NEW POLICY NUMBER: 388-0001308-04. <br /> <br />IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CUSTOMER <br />SERVICE CENTER AT THE NUMBER LISTED BELOW. <br /> <br />EMPLOYER: <br /> <br />CUSTOMER SERVICE REPRESENTATIVE <br />CUSTOMER SERVICE CENTER <br />(877) 405-4545 <br /> <br />KINKLE, RODIGER, AND SPRIGGS <br />3333 14TH ST STE 200 <br />RIVERSIDE, CA 92501 <br />POLICY 0409627-04 <br /> <br />APPROVED AS TO FORM <br /> <br />WI) / <br />-,. . Y~.e oU-/ <br />. ~S S ,{ <br />I' k,:iurU, lilt tlCC Y <br />Assistant Cay ^Jtornev <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 />