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SP <br />' C .OLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-01-2005 GROUP: <br />POLICY NUMBER: 1234182-2005 - <br />CERTIFICATE ID:_. 4 <br />CERTIFICATE EXPIRES: 01-01-2006' <br />01-01-2005/01-01-2006 <br />CITY OF SANTA ANA SP JOB: ALL OPERATIONS <br />COMAUNITY DEV. A6�N0M-'2y ATTN:.D©RRIS <br />SA14TAVANACCATg27o ATJt,- &0, 80>� 73§$ 8 <br />This is to certify that we have issued a valid VJo tiers'. Compensation insurarce policy in a fotm.. approved by the . <br />California Insurance, Commissioner to the employer ,named below. for the polrey period indicated. <br />This policy,is not subject to cancellation by :the Fund except upon lodays' advance written noticwto the employer. <br />We will also give you 10 days' 3dvar 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 after the coverage afforded <br />by the policies listed' herein. Notwithstanding,agy r§quirementT term, or condition of any contract or odie{ document <br />with respect to which this certificate of insurance may be, issuedor may pertain, the insurance afforded.. by the <br />pohbies described herein is subject to all the terms. exclusions and conditions ofsuchpolicies. <br />, <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS::. $1,000, 000:00."PER OCCURRENCE. <br />EMPLOYER <br />LEGAL NAME <br />SAINT JOSEPH BALLET COMPANY SAINT-JOSEPH BALLET COMPANY <br />1810 N MAIN ST (A NON-PROFIT CORP.); <br />SANTA ANA CA 92706 <br />' (REV.3-03) PRINTED 12/17/2004 <br />