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<br />___.~<l/=!.005 _} 4: 38 <br /> <br />323;;504231 <br /> <br />1-I:.JMA,',! F:E";Ou.;:;\CE:'S <br /> <br />STATE <br />cOM,...,..S"-TIOM <br />lH'$UfIt,ANC. <br />FUND <br /> <br />CERTHOt.DER COPY <br />PO sox 420807 SAN FRANCISCO,CA SA 142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />X$SUE DATE: 02-"-2008 <br /> <br />CRO\JP; <br />~OVCv NUMIlER '513180-200& <br />CfRTIF!CATE lO- 100 <br />CE~TlrICATe ~XP1I=teS; 04-01..1.008 <br />01-01-200&/01-01-2005 <br /> <br />CITY OF SANTA ANA <br />PO BOX 1988 <br />SANTA ANA CA 92702 <br /> <br />SL <br /> <br />This I, to certlty thilt W. tl.v. lUlto<t a 'd,',ld \.J"Qr~tf" Comp.ns.tiQn in$uui'1c. POlie;:y in .. form apprc.",.d D" the <br />C'llfornj. InslJrlnce Commiulo".,. tQ t~ .~Ioy.r nMm.d b.IQW for the ooliey p.oriQO Indicated. <br /> <br />Th\~ pOlicy is l'lO~ su'tP}.ct to c::.,.,cell.tlol'l by the Fund. "xcofpt IJptlfi30 ::1<<V$ td....nce writt," notle. to ths employ.,., <br /> <br />w. will .1150 gille 'iClU ~Od.Y$ JdIl'("Ir;;9 notic, shoi.rlc: this OQiicy b. Cf!ncelifliO prior to its normal eX1:,'I)ratiO!"l, <br /> <br />Thl~ e.rti'ic.t~ of in&UrenCB Is 110t ..., In&u,.n~. pO:i(':y Jf\\1 lien not 'mend, ."'f,nd or .~1'.r thtt cO\l,t.g~ .fto"ded <br />by the po\\e~' rst.d r..rei'1. Notwiths.IM'ldlMS my r"q\..ire'Tlffl1t, _ t.rm or eOf'\di~('-:H' O~ Irly Ol;)l"I'l:-ICl, or otl-Jer docurn6n( <br />with ra,p.ct to wt'ti<:h th~s. ~.nifit:at. of in/.iUrilf1(:C rti8V bfI 1$'~8d ;1r 10 wille" !t ~1iI)' pertlln, 111:. Inturanclf <br />.tfcrd.<t by fhe pOliCY a.scrib.o her.in. is 8UtJ,iaet to .U tl't. t.rms. 4'''-Clusicn&, ."d condJelo",. cl &l,lt:h policy. <br /> <br />~ <br /> <br />A~c <br /> <br />~ <br /> <br />AUTHORI ZEe REPRESENT A "\IE <br /> <br />PRESIDENT <br /> <br />~MPLOY'.'S LXA.ILETY CIMIT INCLUDING DE~.NSE COSTS: $1,000,000 PER O~CU~ENC.. <br /> <br />~~$eMINT 62085 ENTl~LEP CERTIFICATa HOLal~S; NOTICE Ef~ECTl~E 0&-01.2002 lS <br />ATTACHEO TO AND 'ORMS A ~A.T O~ THIS pa~lCv. <br /> <br />.,',,'ROVED AS TO ~ ~ ..' <br /> <br />\. ;::Yj:/ <br />~-~) <br />t;:ll.Jn~ Stitt Shccu~ <br />'>,.,,(dnL City AttoIilv <br /> <br />EMPl.OVEFI. <br /> <br />(.'I:J;V .z~o~J <br /> <br />GREATER LOS AWG,LES AGENCY ON DE4FNESS AWD/OR (A <br />~OW-PROf\i PIJ811C UNEfl1 COAP'.) AND/OR LIFESiGNS <br />~Cll ANO/OR (A NON-PROFIT puBLIC S,NHIT COR-.) E1 <br />A, <br />2222 lAVUUr/J AYe: <br />LOS ANGELES CA 90041 <br /> <br />{B16,SL] <br />p_INTta , 02-'.-2005 <br /> <br /> <br />PA'3E 85 <br /> <br />s~ <br />