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SP <br />/� <br />10LDER 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: 08 -15 -2005 . GROUP: 000488 <br />PO�IGY NUMB ER: ,0000679-2005 <br />- CERTIFICATE Imo:... 2 <br />CERTIFICATE EXPIRES: 68 -15 -.2006 <br />08- 1S- 2&Sii/O8-15 -2006 <br />CITY OF SANTA ANA COMMUNITY SP r <br />DEVELOPMENT AGENCY A -25 <br />P.O. box 198 <br />SANTA ANA, CA 92742 -1988 <br />This is to certify . that we have issued a valid Workers' Compensation insurar,,Ce 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 a xtept upon 90 days' advance writtien notecgAo the employer. <br />We will also give you 30 days'- advance'notice should this policy be cancelled pr or 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 Notwithstanchng ;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 ihsOMrtce afforded_ by the <br />policies described herein is subject to all the terms, exclusions and - conditions of such policies. <br />AUTHORIZED REPRESENTATIVE PRESIDENT - - <br />EMPLOYER'S LIABILITY LIMIT INCLUDING ➢EFENSE.COSTS: .. : g1,000,000r0b.PER DCCIIRRENCE, _ <br />ENDORSEMENT #2065 ',ENTITLED CERTIFICATE HDLDE'iRS'.NOTICE EFFECTIVE - '06 -11 2005 IS ATTACHED TO AND <br />FORKS A PART OF THIS POLICY. <br />4P TONED A'S TO FORM <br />A >srn1461. Gity Attorney, <br />EMPLOYER - <br />LEGAL NAME <br />WISEPLACE, A CA CORP WISEPLACE, A CA CORP <br />1411 N BROADWAY' <br />SANTA ANA CA 927o6 <br />07/18/2005- <br />Igev.3 -03l PRINTED. PtjapB <br />