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<br />Sep 15 05 10:47a
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<br />Public Works
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<br />7146473345
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<br />p.4
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<br />CERTHOI.~~R' .COpy
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<br />STATE. RClc 60l<:a07, SAN FRANCJSCQ;CA. ~14i~Q~Q7
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<br />,F;UN D ceRill'ICATEQft:~~~' eoMP~A;'ION ~sURANCE"
<br />lSSUE DATE 'ONHOO5~\:';~~;~":) ':'\':~':<\:GllOU~::' .',
<br />./ .:.,,:z~~;c,'~':,' ' ';p~tCY:#UMBER: 175003t-20oa
<br />" ,::~",;~;~, ~~~~~tt~IR~SI:07~0~-2008
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<br />CITY Of SANTA ANIC .:,
<br />ITS OFFICE~S.E~LOYEES & ~EN~$.
<br />220 SOU1'li OArSY BLOG- A ; ',";:':,,i. ...
<br />SANTA ANA CA ~270,' i~>:": .::..~;'
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<br />\ ,~lli<;.l,l, CAt.jl'ORNIA OPERATIONS
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<br />ThiS is to cliJrtify that we :Ni~B i$s.l!-~.:-._'-~~lid_,w6tk~,r$~- Conj'~Q8a,iOn",':jn~r~c~"pol'icY in a fotm~ a~pro,yod, by the
<br />California I~$t.lrance Commissioner to- th,e"$mpIOytlf _'named below for'.t,hff P9'tfcV period indicated. -,,- . - -
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<br />. T~js polley is not sub-Ject_~.to c:ancell!Jti'on' bY- the F-und,. .x,c:ept, upon 30.~ay$' ~~*e<~ti~';:\':iO~IC~,~ to': the . ~mPloyer.
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<br />We will also give YOU 30' d.ys' '-lIciVai'~$"~.~tic.'e shou.ld' thieS pOI~CY, b~ c.lInceli~'d,:-J?,rior, -~o.rits<~~?"rnav~pjrati~n.
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<br />This certitit:_~te ~f l~$.ur,"~~ is :nO~i:ar.J.;"n~r.~~~ :'P.o';cy" ,.llih;~,t:~,ge~::_,not .I~iJ,d.': ~){tfl,~d:q~' ':a,~l~-":~tt'la '~?V~fage: afforded
<br />bY. the- PQ.hCIBS hstS:d her~~n."-N~~I~ii'ta~,~e ;~~reqlJlr,.,~~t,'l~,,_~.tr:n~ "qr-' ocr,dlbo,:, "bf:fnY.~~~J1~t~t .pt"__.,,~t.h.r.-_ d90ument
<br />w,\t1 ,esp.eLl,,- which thIS eer~hcetl!"o.f,:iI\$~rjir)d. "1IV'/,'b8\\~.".d b( m.y lie"..\' the IQsur.ntl....ftord'd by the '
<br />!,oliei.s de'scrib,ed herelD is. subject ttjl 'al~'~lh'~':):M~:)!)(,.cJ~1,i~s':~f:tq~,~ondition$-;'of, sUCh po!ier8S: -, '" "
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<br />AUTHORIZED 1lEPREsfN'tA TIVE " ..... <f 'I,~sU;>ENj . .',
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<br />EMPL.liYER~SJ.IA1l11.1ty ;LIMiTlkOi:~ING~O~"~1:, ~~~;, $1;* i~. 00 ,P~ OCQij"~ENCl!. .
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<br />.'. ~NlloJlSEMl!N1' t:lOllI--fNTltLE$ \;:tllTtf:X~A~i:l:tlll-~~::.~l9t~FW;ye,~7-oH0051S A:rTl\CH~#.rO: AND
<br />'. PeRMS A PART OF THIS pOj,.1~ . A. '. .v'''''-'\''' ,.., - " t" "
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