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11, <br />08/05/2005 13:58 <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />I"'rU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATEt 08-05-2005 GROUP. <br />POLICY NLUDER. 1900611-2004 <br />CERTIFICATE ID 1 <br />CERTIFICATE EXPIRES: 10-29-2005 <br />10-29-2004/10-29-2005 <br />CITY OF SANTA ANNA Sp <br />cDBG ATTN: FRANK HERNANDEZ <br />20 CIVIC CENTER PLAZA P.O. BOX1999 <br />SANTA A6NA CA 92702 <br />This is to certify that we have issued a valid Worker{ 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 Polley is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br />We will also give You 10 days advance notice shoWd this policy be caneslied prlw to its normal expiration <br />This certificate of insurance is not an insurance policy and does not amend, extend or altar the coverage afforded <br />by the Policy listed herein Notwithstanding any requirement, term or condition of any contract or other document with resCact to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />A�, e , M-IL <br />i <br />AUTHORIZED REPRESENTATNE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />RNIPLOYER <br />SOUTHWEST MINORITY ECONOMIC DEVELPMNT AS SP <br />1901 W 2ND ST <br />SANTA ANA CA 92703 <br />' ! (AEY.2-05) <br />NO.276 9002 <br />APPROVED AS TO FORM <br />...aura Stitt Shoe by <br />.»,.tant Cry Attorney <br />[SC2,CN] <br />PRINTED : 08-05-2005 <br />SP <br />9 <br />