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SP <br />_ERTHOLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMORNSATION <br />INSURANCE ; <br />FU N O CERTIFICATE OF WORKERS' 'COMPENSATION INSURANCE <br />ISSUE DATE: 03-28-2005 - GROUP: <br />POLICY NUMBER: 1810814-2005 <br />-- - . CERTIFICATEID: _ 44 <br />CERTIFICATE EXPIRES: 03-28-2006 <br />03-282005/03-28-2008 <br />C ITY ,OF SANTA-SP' JOBS ALL OPERATIONS <br />CDBG M-2§ ATtWi CARLA,TNOMPI�,WS <br />P.O. BOX 19p i 29 <br />SANTA ANA CA -92705 <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 .j0 days' advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of jinsuranae is not an irlsurance policy and does not amend, extend or alterthe coverage afforded <br />by the pol ies listed herein Notwithstandk4 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 />pglicjes described herein is subject to all the terms, exclusions and conditions of such policies. <br />�►- X. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S' LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,006,000.00 PER OCCURRENCE. <br />,COAlo3jt7�ii;^/ 7nRlstccd <br />_ dpPc%t{C ltf lc. CtOE"' <br />"01 01 Sb ,Q19Aoxddd <br />EMPLOYER ....... <br />.LEGAL NAME <br />]. WOMEN'S-TRANSITIONL LVNG"CNTR, INC WOMEN'S TRANSITIONAL LIVING CENTER, INC <br />PO BOX 6103 <br />ORANGE CA 92863 <br />