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SP <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: 05-01-2005 GROUP: <br />POLICY NUMBER: 1511887-2005 <br />CERTIFICATE ID: 30 <br />CERTIFICATE EXPIRES: 05-01-2008 <br />05-01-2005/05-01-2006 <br />CITY OF SANTA ANA SP JOB: ATTN: KENT JORGENSEN <br />PUBLIC WORKS AGENCY M-36 <br />PO BOX 1988 <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 <br />PRESIDENT <br />EMPLOYER'S ,LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05-01-2005 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />AY 'P•,OVLI <br />I_aurrl .titin' <br />AaSistant Sh,;c . <br />C=ity 01p, <br />EMPLOYER <br />LIDGARD AND ASSOCIATES, INC <br />2808 E KATELLA AVE STE 107 <br />ORANGE CA 92867 <br />LEGAL NAME <br />LIDGARD AND ASSOC, INC <br />REV.3-03) PRINTED., 04/15/2005 r•0 <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCiF 10265 <br />