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SP <br />t SOLDER COPY <br />STATE P.O. BOX 807, :SAN FRANCISCO,CA 94142 -0807 <br />COMPENSATION INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08 -15 -2005 GROUP: 000488 - <br />POLICY NUMBER: 0000879 -2005 <br />CERTIFICATE ID:_ 2 <br />CERTIFICATE EXPIRES: 68 -15 -2008 <br />08 -15- 2005/08 -15 -2006 <br />i <br />CITY OF SANTA ANA COMMUNITY SP <br />DEVELOPMENT AGENCY M -25 <br />P.O. BOX 1988 <br />SANTA ANA, CA 92702 - 1988 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the Polley period indicated, <br />This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice, to the employer:' <br />We will also give you 30 days advance notk2e should this policy be cancelled prior to its normal expiration. <br />gl <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policies 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 may pertain, the insurance afforded: by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies.. <br />A _ e <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:., $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT X2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08 -15 =2008 IS ATTACHED TO AND <br />..FORMS A PART OF THIS POLICY. <br />ARrR01'E1i AS 'PO FORM <br />ftlln .Lill >uee�y'� <br />City Attorney <br />EMPLOYER <br />LEGAL NAME <br />WISEPLACE, A CA CORP WISEPLACE, A CA CORP <br />1411 N BROADWAY <br />SANTA ANA CA 92706 <br />(REV.3 -03) 07/18/2005 <br />