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<br />x <br />"~ <br /> <br />""" <br /> <br />A-dWD-04g <br /> <br />STATE! <br />COMPENSATION <br />INSURANC'E <br />FUND <br /> <br />p.o:'eO)(420807, SAN FRANCISCO, CA\l4142;baQ7 <br /> <br />CERTIFICATEIPF WORI<ERS'COMPE.l\ISATIONI",SURANCE <br />.,...,.cc.'y_ . ': ". ,-'," ".' ... >..,'<. ...--......, <br />NOVEMBER 15, 2002 POLlCVIIlUMElER:"8B-02 UNIT 0000H,8 <br />CERTIFICATE EXPIRES,4,...1-03 <br /> <br />I <br />CITY OF SANTA ANA <br />ATTN LUCY FLORES <br />POBOX 1988 <br />SANTA ANA CA 92702 <br /> <br />L <br /> <br />This IS to certify that we have issued a valid Workers' CompenSatiopil)suranCll poliCy in a form approved bY the California <br />Insu<anee Commissioner tojhe employer named bel6wfor the. policy peciDdindicatJ3d. -.--- - -- <br /> <br />This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. <br /> <br />We will also give you TEN daYS' adVance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This cer\ific~te ofin~un:il)Ce. is not allirisu~anbe policy and does not~me';d, e;ctel)cj!o~alter the coverage affOrded by the <br />poliCies Ii~ted herllin. Notwithstanging apy requirem"nt, term, or condition 9f.any contract or qtner dopumentwith <br />respect to. which this certificate of insurance m"y 'l:1alSS~ecj s" maYpert"in,.th,,' insurance afforded by! the policies <br />described herein is subject to all the termsiexclusionsand corQ4!iOns of such policies. <br /> <br />/?~~~ <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />K~ <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIMlILIT'i' LIMIT mCLUnJNG llEF'ENSECOS.TS= $1,000,000 P Ri OCCU~RE.NCE. <br />'. <br /> <br />APPROVED TO FORM <br /> <br />~!tI~t-u-# <br />I:aut-lLSheedy . .' <br />Deputy City <br /> <br />EMPLOYER <br /> <br /> <br />I <br /> <br />ANAliEIM "INTERFAITH SHELTER INC <br />626 N PAULINE 5T <br />ANAHEIM CA 92805 <br />