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SP <br />cRTHOL[7ER COPY <br />~TA7E P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPi~N SATION <br />1.,N;SURANCE <br />~U N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03-28-2005 <br />CITY QF SANTA ANA <br />ESQ-GOA, ATTM: M'IKf LINAR'ES <br />P.o. r3oz t988 M-z5 <br />SANTA ANA C,A.'g2705 , <br />GROUP: <br />POLICY NUMBER: 1610814-2005 <br />CERTIFICATE ID: 43 <br />CERTIFICATE EXPIRES: 03-28-2006 <br />03-28-2005/03-28-2008 <br />SP JOB: ALL OPERATIONS <br />This is to certify that we have issued a valid Workers Compensation insurance policy in a form approved by the <br />Cairfor»ia Insurance CommissiGnef to the efr?ployer named below for the palicy period indrextetl- <br />This policj< i5 not sutiject to, cdncehatiort by the Kund except upon 10 days advance written notice to the employer. <br />We vviil also give yqu 10 dxys'~ advance rtofce shQuitl thrs Policy be cancelled prior to fts normal expiration. <br />TMs certifiicate of ihsurance, Is-riot an +nsurarce poiicy and'` does not amend, ,extend or .alter the coverage afforded <br />by the policies Rste`'d herein Nofvvithstanding, any requirement, term, or co»dition. of any contract or other ddcument <br />with respect ~to. Whieh this cetfificafe of +nsurance may' be issued or may pertain, the insurance afforded Sby the <br />policies described herein is subject to alf+the terms.. exclusions and conditions of such policies. <br />AUTHORIZED REPRESENTATIVE ~- PRESIDENT <br />EMPLOYERS LIA6,TLITV LIMIT INCLUDING D~FENS€ COSTS:.. $1, 000, 000.00 PER OCCURkENCE <br />- ~= /~ <br />A. i ; / <br />~s <br />,-~e.~ <br />Laura •st,t <br />{ kt~~dv <br />' Ass~gc~` ~ <br />' ~ _ " R~'Ci4y Attorney. <br />: ~ ~'EM1APLOYFR <br />WOMEN'S TRANSITIONL LVNG CNTR. INC <br />PO .:BOX 6103 <br />ORANGE LA 92863 <br />~~ <br />~~~ <br />V <br />EGAL NAME <br />WOMEN'S TRANSiTIONAL LIVING CENTER, INC <br />' IREV.3-o3) 02/17/2005 <br />~ • ~ C • ~ <br />