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<br />IJ - ;JCD S- I dO <br /> <br />POUCYHOLDEq{ LLH.P{ <br /> <br />STATE <br />COMPt::N~ATitON <br />IH!i-'UBANCt: <br />FUND <br /> <br />PO BOX 420807, SAN FR4NCISCO,CA 94142 0807 <br /> <br />ceRTIFICATE OF WORKIiHS' COMPENSATION INSURANCE <br /> <br />Z SSUE OAr E ; I.' 28 200!:i <br /> <br />G!1OUp' <br />P{)] Ie." r,~~n. l801464-7oo5- <br />C~~4 t,PICA TE: .\1)- 7; <br />Ci:JHlfICATE C:(PIRES~ 10-01-;2{)t)rG <br />10.01-2005110-0'-2006 <br /> <br />CITY ot- SIUITA ANA <br />VINU NOUY,EN <br />2.0 CIVIC CEHTt;R PLAZA <br />SANT.A ANA CA 9Z702 <br /> <br />56 <br /> <br />"''';';' is L-o f,;"Qrtify th..t '.Vo have i:::;uua 111 ,,';,;Iid \i\'O;ht.~L:..' Com.pe-l\a'io", H'l$J.Ji;:;!1::~ POm~y in ... term loQil'rc..."d b'l th.~ <br />C;,;JirQlfOi.. !t\r>:;r<llv:a:, Commi5.:!::rH'l~; ~o i;h~ (1;i'!l':lIl.:lIf'r !1:;med bel~'N flY tn'll pori,::,y ;:H'I\"fO<1 Indic.1i{~d. <br /> <br />n~i5> p-oh'Cy is HQT ~~ibJeCl \n c;;I<'"}::-0,1;'j1l'(':1) lJ,"( lJ'\e Fi,K\d e,Xr::~T3t ~II'O"" 10 d~'", lktv.\M.:;e w:r;tl8it"l ;"'twtlC".:! h) tl:o emp!c.'(~ <br /> <br />\iV~.: ..~t11t <11$0 '9:'''-1;" you 10 tJit}ii adv...-.,;;". nQtice ~~r.m,fd :fro::,r. ~(Jl!CY be c~.tnH",>t1 Pll~)l" fo i'bi ne,r,T,..,t <Qxprf.)'U^"'" <br /> <br />'1'+,,:;: condi;;;~r, 01 t;'~IUI"'.:.l.r1<:~ ;~ no~ J}'! d<:;.lli'.an;:::O !')ola;y .\;FiC d~~ "lot ,)ffl'~nv. o",tet"d~";lfk'.'r 1~ (;:0"'1'1;";;", .ff~l.;,vdt;'J <br />uy the PO(u: if Ii>; t!!"Jtvn't'in. Nr}'rN:1h'!;<t~t;jjl".g ;V1I f1M;lUitement ~jijrrr'l ew COwJ.ltilj<n o,f .If':,' 1;';~H>Jf.ac[ nr "')tl1e.;,, docorl"ton~ <br />",....,..lth "'o'! pvc\ ~c vlhkh tt1i~ (;j).i ti f;c.3tt'l '0 r ~nswr U1CC m..J.{ be l!.$ul,:d ~ 10 y..hi.-;h it ~~ :P~ t.<Nn. tho; in:;\.:{! ",nee <br />_;lfiord",:1- by 1he- pnlf.o'r ~!:j..c(lJ)nd herein 110 ?jt:l~:f>C{ TO .'n Vl.t? tMm:i. C">ie:~ibn~. ar.d (:C::"'1:1it;on$. of !:.u~ih (){.1i1-(~'._ <br /> <br />{y::/JufJ.Alt.---- <br /> <br />Ah-~ c <br /> <br />6!i~ <br /> <br />AUrHl...h1~Zc.c H!i:PRESt,;t;TA TN!:; <br /> <br />PRFSrC,:t:N1 <br /> <br />C::MPLOYt:R'S LIABILITY LI~Il' INCLUDING DeFENSE COSTS: <br /> <br />S1.000.000 PER OCCtJflRENCE_ <br /> <br />EJ"OOaSENENT #1600 - dOHN THAI PRESIO[NT SEe, - eXCl...OOiEO" <br /> <br />'......26'. A <br />'---<- .-: <br />Ie <br /> <br />FW.f.'1_ C',' f:h <br /> <br />AOVAHCt:D ''t RAN~PORTATHJH CONCI::PTS URP. IN SG <br />14 50:RI:NSOH <br />1~vlN'E CA 92801 <br />