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JUL-29-2005 09:00R FROM: T0: 17146476549 p,z <br />* ~i2,9/2005 07:47 N0.439 D0B2 <br />SP <br />POLICYHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCiSCO,CA 94142-0807 <br />COtMPRNBATIQN <br />1w5upANCB <br />FUND C6iTIFICATE of WORIOepb' COMPfiMSATioN MI$URANCE <br />Issue pATC: 0729-2008 GppUP: <br />POLicr NlL61R neafst-:OOs <br />CSiT1FICATE ID: 1 <br />C6iT1PIGTE !%PIRES: 0•-14-2008 <br />a-u-sowia-u-soon <br />TNiS cERTIFICAT[ SUPFRBEOES AND COR1tECtS <br />ceRTlr:cAT~ - s iu-Teo m-s~-tooS <br />CITY Of lANTA AMA <br />2D CIVIC Cti/R!R PU12A <br />SA}tTA ANNA CA Ra702 <br />SP <br />Tbla b b wruN Hurt ove haw Issued a valid Workers' GoNgansatfen Insuratte• peDey b a term approved try tha <br />Glifomk InstPRtE• t.01MMeefOn•f to tfl• NnPIeY•r !coed below for pie AOeCy P~ k~dpated <br />This policy k Iqt subject b oanCMWlon 0V tty f9•td •xdpi teen f0 drys sdvsnes mhtsn notice to the employer. <br />We wilt else tihti vtw 10 dsye adwna ro8u shdld thk pdieY be ancel4d Prlor to ib normal aucplrtidt <br />Thk CerdNeete o1 uNVate• k net r Inunce pokey sod doss not anen4 extend d Nter tn• eavsra8• attdded <br />b4 the Policy Mated lwein NOMn'RwhMir~p aiN r•Otthrrnent Umn ar eerkitidt of any contract d otMr document <br />wltb Iapset to vddeh thb Lrortilipb of YpvRtee msy tw iswed or to wBteh it may Pertain the arvnea <br />afforded by tM PolieY daeribed hrein N abjsa no a0 the tsrmy exclusions, Rd egrslitWrn, or stph poky. <br />~~°~'- A c . tom. <br />ALhNORIZED REPaE,4FMATiVE PNt~S10FJJT <br />EMPLpYBR'B LIABILITY LIMIT IMCLIIDINB DEFENSE COSTS: 91,000,000 PER 000{IRApICB. <br />~~ <br />~~. LISA E. gfOR{ KneY r <br />Assistant City <br />EMPLOYER <br />OaAMOi CpIBrtY CHILORFJI~s TiIERAPEUTC ARYB .SP <br />208 N BRDADYAY <br />SAMrA A14 CA 82701 <br />IM~.CM <br />WE1/.i-aet •RWrEO c 1Y7-29-2005 <br />