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SP <br />_RTHOLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INS UFtAN CE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03-28-2005 <br />CITY OF SANTA ANA Sp <br />ESQ-CDA, ATTN: MIKE LINARES <br />P.O. BOX 1988 M-25 <br />SANTA ANA CA 92705 <br />GROUP <br />POLICY NUMBER: 1610814-2005 <br />CERTIFICATE IDs, 43 <br />CERTIFICATE EXPIRES: 03-28-2006 <br />03-28-2005/03-28-2006 <br />UOB:ALL OPERATIONS <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 policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 10days' 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 />by the policies listed herein Notwithstanding any requirement, term, or condition of any contract or otherdocument <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 />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000_00 PER OCCURRENCE. <br />r <br />Laura Stitt heedy <br />Assista, C <br />itY At[orner. <br />EMPLOYER <br />WOMEN'S TRANSITIONL LVNG CNTR, INC <br />PO BOX 6103 <br />ORANGE CA 92863 <br />LEGAL NAME <br />WOMEN'S TRANSITIONAL LIVING CENTER, INC <br />02/17/2005 <br />