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SP <br />., HOLDER 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: 07-01-2005 GROUP: 000469 <br />POLICY NUMBER: 0001646-2005 <br />CERTIFICATE ID: 35 <br />CERTIFICATE EXPIRES: 07-01-2006 <br />07-01-.2005/07-01-2006 <br />CITY OF SANTA ANA SP JOB: <br />COMM DEVELOP. AGENCY M-25 <br />P.O. BOX 1988 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Workers' Compensation Insurance policy ina 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 amend, extend or alter the coverage afforded <br />by the policies listed herein. Notwithstanding 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 />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 />ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2005 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />AS 'TO rOiZM <br />EMPLOYER <br />MARIPOSA WOMEN'S CENTER, INC. <br />812 W TOWN.AND COUNTRY RD <br />ORANGE CA 92868 <br />.LEGAL NAME <br />MARIPOSA WOMEN'S CENTER, INC. <br />(A NON-PROFIT CORP.) <br />(RE V.3-031 <br />PRINTED: 06/17/2005 <br />