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SG <br />POLICYHOLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-01-2004 GROUP: <br />POLICY NUMBER: ISS9551-2004 <br />CERTIFICATE ID: 283 <br />CERTIFICATE EXPIRES: 09-01-2005 <br />09-01-2004/09-01-2005 <br />CITY OF SANTA ANA PUBLIC WORKS SG <br />20 CIVIC CENTER PLAZA M-93 <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 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 />A c . 64 <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2004 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />LEIGHTON GROUP, INC. <br />17781 COWAN STE 100 <br />IRVINE CA 92614 <br />(REV.3-03) <br />\1) r(jeZlJ6 <br />Cty <br />i <br />LEGAL NAME <br />LEIGHTON GROUP, INC. <br />PRINTED: 08/17/2004 <br />