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<br />CERTHOLDER COPY <br /> <br />SC <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 05-10-2006 <br /> <br />GROUP, <br />POLICY NUMBER, 1805826-2005 <br />CERTIFICATE ID, 170 <br />CERTIFICATE EXPIRES, 10-01-2006 <br />10-01-2005/10-01-2006 <br />THIS CERTIFICATE SUPERSEDES AND CORRECTS <br />CERTIFICATE # 169 DATED 02-23-2006 <br /> <br />THE CITY OF SANTA ANA <br />60 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4060 <br /> <br />SC <br /> <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 /> <br />This pOlicy is not subject to cancellation by the Fund except upon 30 days adllancoa v~ritten notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the polley 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 to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms. exclusions, and conditions. of such policy. <br /> <br />a:::-REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1600 - RONALD FARWELL PRESIDENT - EXCLUDED. <br /> <br />ENDORSEMENT #1600 - BARON FARWELL SEC,TRES - EXCLUDED. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2005 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />'P, '; <br /> <br />l'ORM <br /> <br />EMPLOYER <br /> <br />>>;J,' ! <br />.'. ._J'6!kJ'-.eC^(V-....-:-.-.. - <br />LlU" ':f:~:,:. <br />.>i::;t,,:,): <br /> <br />(j;'\ <br /> <br />ALL CITY MANAGEMENT INC <br />1749 S LA CIENEGA BLVD <br />LOS ANGELES CA 90035 <br /> <br />SC <br /> <br />(REV.2-05) <br /> <br />') n <br />L )'-., <br /> <br />PRINTED <br /> <br />[B14,SC] <br />05-10-2006 <br />