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a 00/25/2005 11:53 7145715079 LEGAL SOCIETY P— 7 C PAGE 02/02 <br />POLICYHOLDER "OPY SP <br />STATE P.Q. BOX 420807, SAN FRANCISCO,CA 94142— - <br />COMPENSATION <br />IN S•URAMC a <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-01-2005 GROUP, <br />POLICY NUMBER: 0770319-2005 <br />CERTIFICATE ID. 92 <br />CERTIFICATE EXPIRES: 09-01-2008 <br />09-01-2005/09-01-2000 <br />CITY OF SANTA ANA SP <br />ATTN JOFN MALONEY <br />20 CIVIC CENTER PLAZA <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 <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 30 days advance written notice to the employer. <br />We will also give you 30 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 arrlend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, tarm Or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the Insurance <br />afforded by the policy d*5Cribed herein is subject to all the terms, exclusions, and conditions, of such policy. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,O0O,000 PER OCCURRENCE. <br />ENDORSEMENT a'2065 ENTITLED CERTIFICATE HOLDERS, NOTICE EFFECTIVE 09-01-1990 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />LEGAL AID SOCIETY OF ORAME COUNTY (A sp <br />NON-PROFIT CORP.) <br />902 N MAIN ST <br />SANTA ANA CA 92701 <br />IREv.ToSI PRINTED : 0s-17-2005 M0410 <br />