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FROM :CDR ADMIN/ECON DEV FAX NO. :7146476713 Feb. 27 2006 12:24PM P3 <br />. -. $P <br />_i L, AHOLDER COPY ,. <br />STATE P,a sox 420807, snN F�An►asco,cA'9a1a2 -oso7 <br />.. COMPENSATION <br />.ANSVPtANCE <br />FUND ce mwicA7E OF. WORKERS' COMPEWATION WSURMCE <br />ISSUE DATE: 09- 08:2005 - GROW . <br />. POLICY NUhilaM 1703487 -2005 . <br />.. .. .. CERTF XATE D 23 <br />CERTMATE EXPM5: 07-01 -2008 <br />. - 07- 01- 2005/07 -01-2008 - - <br />-CITY OF SANTA ANA -COM M -25 SP . <br />'COMWWTV DEVELOPMENT AGENCY . <br />P 0 BOX 1588 M -25 <br />SWrA ANA CA ;22702 <br />.. This is to WON Gist vre have issued a valid Workers' Conpmuation insurance Policy in a form smvved by fie . <br />... ,... Cdlfontla .kwxw4e.Ccwm{ssiOtw t0 tlw atrployer 'named below for tlla_ptjpcy JWJod. indksted— <br />This Policy, It not subject to comWistion by the Fund except upon 10 days advance written notice to the employer. <br />We will also'9rve you.10 diva advance notice showit this policy be cancelled prior to ifs nomW expiration <br />.. This cortifiesto of inaranos is not an insurance. policy and does not amend, extend or alter the coverage afforded . <br />.. by the Polity listed heron. Now sty requirement -tam or. condition of arty contract w other doasnent . <br />with respect to vvWch Sus' certifwse of may be issued or to which it may partari the insurance <br />Oforded .by tM policy described twain is subject to all the farms, exclusions, and cortMons, of such policy. <br />_ <br />Aiz, . <br />AU7MMZED REPRESENTATIVE PRESlOENT <br />EMPLOYER'S LIABILITY UNIT INCLUDING. DEFENSE COSTS: 11,000,000 PER OCMMKOOCE. <br />AMOVE.D AS TO FORM <br />EWLO,YER . <br />S`LTtt S}t�Y _ +' <br />GALI? FIRE �BOYS a GIRLS .CLUB SP 4=t .C1t3' Atl01-ney <br />14742 PLAZA DR STE 205 <br />TUSTIN. CA 82780 <br />... - PRINTED 00-09-2005 <br />atEV.3 -061 - ' <br />