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SP <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94742-0807 <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: 1788151-2005 <br />CERTIFICATE ID: 4 <br />CERTIFICATE EXPIRES: 04-14-2008 <br />04-14-2005/04-14-2008 <br />THIS CERTIFICATE SUPERSEDES AND CORRECTS <br />CERTIFICATE N 3 DATED 07-28-2005 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA CA 92702 <br />This is !o cer!ify that wre have issued a valid Workers' Compensation insurance policy in a form approved 6y 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 f0 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 by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />~_ C . l~ <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />ORANGE COUNTY CNILOREN'S TNERAPEUTC ARTS SP <br />208 N BROADMAY <br />SANTA ANA CA 92701 <br />[MG2,CN] <br />IREV.2-osl PRINTED 07-29-2005 <br />