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<br />- - <br /> <br />\"..i <br /> <br />"-' <br /> <br />STATE <br />COMPEN~ATlqN <br />I NSUJ;JANQE <br />FUN.D <br /> <br />Bqx420807, SAN FRANCISCO, CA 94142'0~b7 <br /> <br />CERTIFICATE QI'! WqRI(ERS'CQMPENSATIONINSURANCE <br /> <br />SEPTEMBER 1, 2002 <br /> <br />POLICY NUMBER: <br />CERTIFICATE EXPIRES: <br /> <br />0776319 <br />9-1-03 <br /> <br />I <br /> <br />CITY OF SANTA ANA <br />ATTN -:iOtl~J 1'1 ALONEY, <br />20 CIVIC CEI-ITER PLAzA <br />Sr.Nff, MJA CA 92702 <br /> <br />L <br /> <br />This _is to certifythat'we have ,iss~ed_a vali~ 'Y\'orkers~ClJrnpensati;o~)~sl:1r~nc~_policy in a form app'roved ,by,the California <br />Insurance Commissioner hthe-enfployer named below for the policy peiibglnqicated. - - -- - - <br /> <br />This policy IS not subject to cancellation by the Fund~xc~pt upon ti.lh days advance written notic.e to the employer. <br />XX <br /> <br />We Will also give you ~~daYs' advi'.r1ce notice Should thiS policy be cancelled prior to its normal expiration. <br /> <br />This certifiCate a/insurance is not~i~suranbe policy and doeS not amend" extend;callE,r the coverageafforded by the <br />policies Ii~ted, herein N(}t",ithst~l)9it1l1anyrequirem~~t,term, or condition of!lny: contractor otherqqcument\'i'tb <br />respect to'whlchthis certificafe of insuranpem4y'b'eissgeQ or may pertain,lheinsurance afforded tiyjhe policies <br />deSCribed h~reinis subj6ct to all the lerms, exo!Usiqns, and c6rdllions of such policies. <br /> <br />;7~~~ <br /> <br />AUTHORIZEDAEPRESE-NTATIVE; <br /> <br />ii, <br />>, <br />. <br /> <br />K~ <br /> <br />PRESIDENT <br /> <br />E1'IF'UJYER'S LIABILITY UMIT )NCLUIlING DEFENSE: OtlSTS: $1,000,000 PEF: <br />;J. <br /> <br />e, " <br /> <br /> <br />ENDORSEI~ENT 112065 ENTITLED tERUFICATE HOLDERS 'NOTICE EFFEC,UVE <br />09/01102 IS ATTACHED TO ANn FORMS A PART OF THIS POLICY. <br /> <br />-I <br />, <br />, <br /> <br />EMPLOYER <br /> <br />, AS 'TO FORM <br />APrR~YED:J' &?~' <br />~y <br />J.., I,a City Attorney <br />DepUty <br /> <br />I <br /> <br />l.EGAL A'IDSOCIEn <br />902 N MAIN ST <br />SANTA ANA CA <br /> <br /> <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND self 0026' IREV 5-01) <br /> <br />L <br /> <br />i!~127-1II <br />