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SP <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07-28-2005 GROUP: <br />POLICY NUMBER: 1796151-2005 <br />CERTIFICATE ID: 3 <br />/~ '~plc~/ - ~~~t/o~~ CERTIFICATE EXPIRES: 04-14-2008 <br />/v '-' v w Od-14-2005/04-14-2008 <br />CITY OF SANTA ANNA <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA CA 92702 <br />SP <br />This is to certify that we have iswad 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 10 days 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 insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />6y the policy 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 to which it may pertain, the insurance <br />afforded 6y the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />~~>~ C . ~ <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING OFFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />ORANGE COUNTY CHILDREN'S TNERAPEUTC ARTS <br />208 N BROADWAY <br />SANTA ANA CA 92701 <br />IREV.2-05) <br />SP <br />[SC2,CN] <br />PRINTED 07-28-2005 <br />