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SG <br />/� <br />CERTHOLDER 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: 12-31-2004 GROUP: <br />POLICY NUMBER: 1763833-2004 <br />CERTIFICATE ID: 54 <br />CERTIFICATE EXPIRES: 12-31-2005 <br />12-31-2004/12-31-2005 <br />CITY OF SANTA ANA SG <br />REDEVELOPMENT AGENCY <br />20 CIVIC CENTER PLAZA M36 <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 />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S ` LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT lf2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE'12-31-2004 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />:'."ROVED AS TO FORM <br />tt Sheed <br />y <br />Assistant City Attorney - <br />EMPLOYER <br />-LEGAL NAME <br />PARAGON PARTNERSPARAGON PARTNERS, LTD <br />5762 BOLSA AVE, #201 <br />HUNTINGTON BEACH 'CA 92649 <br />(REV.3-03) oouirc�. 11/17/2004 onn <br />