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<br />Apr <br /> <br />01 08 03:39p <br />._v~""~"- n,.,",,'U'~lIl1u.""O <br /> <br />Public Works <br />I-a)clU lobO 378-4301 Tn Them..!;. 0 <br /> <br />7146473345 p.4 <br /> <br />Date 4/1/200B 1113AM Plilge .::or4 <br /> <br />CERTHOI.OER COPY <br /> <br />SG <br /> <br />STATE <br />COMPENSATION <br />INSU~ANCE <br />FUND <br /> <br />P,O, BOX 420B07, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE OATE: 04-01-2008 <br /> <br />GROUP <br />POLICY NuM8L~ 18S6779-2OO8 <br />CER1IFICAT[ 10: 4 <br />CERTIf'CATE eXPIRES, 02-01-2009 <br />02-0'-2008/02-01-2009 <br /> <br />CITY OF SANTA ANA <br />DEPARTMENT OF PUSCIC WORKS <br />220 5 DAISV AVE <br />SANTA ANA CA 92703-4334 <br /> <br />SG <br /> <br />rhls is lu cerUy that we hove issLOed a 'IIalid Worlo.ers' CompEnsation insur.ance poliev .n . for:n approved by the <br />C.;..ifornis hsurance Commissioner :0 the efl1plove-r named ba:ow tor lhe ;JOhe, jHl('od ,ndicated. <br /> <br />Tlll'~ ;..JOlley IS not SL.bJ6CI to c.a'1cellatlO'l by the Fund exce>o;: Jpon 10 aays ..d....lI'lce v\ntten notice to the ~mPIQr'er. <br /> <br />'oNe Will also gl1l8 '/01.. 10 days ad~'aroce "'Iohce should thii. ;::Jolley oe cancelled prior to Its norm&! e.xjJifation. <br /> <br />lhl~ ~ertllicill~ uJ I'lSUfiilll,;e 13 nol an inSUr4nt:e poliCY ar.d ODes 'lOl 4mend, extend ur lIlter lhe coverage affOlded <br />by thll policl 'I.:;.ted here.n. NctwithStanCIinll any reQUir8lY'ent, ~Elfll1 0: cO'1ditlon 0+ i"'lY :ontrJlct or other r:1oc:umen1 <br />with reSDect te whlc~ this certificate of i'lsunmce may Of' ISSU.eO or to .......hich it mi:lY pertain, the insurance <br />;]florded by ,ht/ poliCY described r>erOln IS ;;;ubJeC:l to all the terms el(c.lusIO.,S, and conditions, of such policy_ <br /> <br />',eORIZED REP::::O ~~t~ <br /> <br /> <br />EMPLOYER'S lIABILIT~ LIMIT INCLUOINO DEFENSE COSTS $1.000.000 PER OCCURRENCE, <br /> <br /> <br />EMPLCY!;R <br /> <br />CLINICAL LABORATOAIES OF SAN BERN AND/OR GEO <br />MONITOR INC <br />PO BOX 329 <br />SAN BERNARDINO CA 92402 <br /> <br />(REV 2-1l"'1 <br /> <br />j1D <br /> <br />IB1S,NAI <br />PRINTED 04-01-2008 <br />