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1LDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142 -0807 <br />COMPENSATION <br />INSURANCE <br />FUN O CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 12 -06 -2004 GROUP: <br />POLICY NUMBER: 1528845 -2004 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 01 -01 -2005 <br />01 -01- 2004/01 -01 -2005 <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT AGENCY (M -2S) <br />PO BOX 1988 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Workers Compensation insurance policy in a form approved by the California <br />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 10 days 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 by the <br />policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy <br />described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />AUTHORIZED REPRESENTATIVE <br />SCE _ c Al <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />AMERICAN ON TRACK (A NON - PROFIT CORP) <br />PO BOX 4141 <br />TUSTIN CA 92781 <br />FFN.SPI <br />SQF 10262E PRINTED'. 12 -07 -2006 <br />Accepl INS certificate only 4 you see a faint watea a* that rea s'OFFIDIAL STATE FUND DOCUMENT' PAGE i OF 1 <br />