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<br />CERTIFICATE HOLDER COpy <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br /> <br />FUN C CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />JANUARY 6, 2003 <br /> <br />GROUP; <br />POLICY NUMBER; 428297-2002 <br />CERTIFICATE 10; 38 <br />CERTIFICATE EXPIRES; 09-24-2003 <br />09-24-2002/09-24-2003 <br /> <br />CITY OF SANTA ANA <br />ATTN NABIL SABA <br />POBOX 1988 <br />SANTA ANA CA 92702 <br /> <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />Insurance Commissioner.to the employer named.beJow for the policyperrod indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 3Q days advance notice should this.policy.becancelled prior to its normal expiration. <br /> <br />This certificate of .insurance is not an insurance:policy_and does not amend, - extenp or alter the coverage afforded by the <br />policies listed herein. Notwithstanding any requirement, term Orcohdition of ariycohtract or other document with <br />respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br />described herein is subject to all the terms, exclusions, and conditions, of such policies. <br /> <br />-d <br />/#~ ~ <br /> <br />1(~~l...L-~'&A. <br /> <br />PRESIDENT <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-24-2002 IS <br />ATTACHED TO ANOFORMS A PART OPTHIS POLICY. <br /> <br />EMPLOYER <br /> <br />APPROVED AS TO FORM <br /> <br />La~~ <br /> <br />Deputy City Attorney <br /> <br />BEAVENS SYSTEMS, INC, <br />2200 PACIFIC COAST HWY <br />HERMOSA BEACH CA 90254 <br /> <br />selF 10265 <br /> <br />rEPF-UI: JT I <br />