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<br />- "- <br /> <br />,0 <br /> <br />, <br /> <br />STATE <br />COMPENSATiON <br />INSURANCE <br />FUND <br /> <br />p,o. Bo.X 420807, SAN FRANCISCO., CA 94142-0807 <br /> <br />CERTIFICATE OF WQRI<ERS'COMPENSATlON INSURANCE <br /> <br />SEPTEMBER 1~ 2002 <br /> <br />POLICY NUMBER; <br />CERTIFICATE EXPIRES: <br /> <br />0776319 ., 02 <br />9-1-03 <br /> <br />,- <br /> <br />CITY OF SANTA ANA <br />AnN JOHN MALONEY <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />L <br /> <br />This is to certify that we have issued a valid Workers'Compensation insurance pOlicy in a form approved by the California <br />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 ~ days' advance written notice to the employer, <br />XX <br /> <br />We will also give you:WN days' advance notice should thiS policy be cancelled prior to its nO,rmal expiration, <br />XX .; <br /> <br />/7~'~~ <br /> <br />AUTHOAIZED REPRESENTATIVE i <br /> <br />'" <br />, <br />~~." <br />'. . . . .'.-;<- <br />: ~. ~ . -. : . - ::.' :., <br /> <br />'PRESIDEf\iT <br /> <br />".' <br />EMF{OYER'S LIABILITY trMITINCLljDI,NG DEFENSE Cb$TS: $1,000,000 F' R OCCURR'ENCE,~' <br /> <br />. <br /> <br />EtJDOF:SEi1nn ~2065 ENTITLED 'FE,RIIFltATE HOLDERS 'NOTICE EFFECTIVE <br />09/01102 IS ATTACHED TO ANn 'FORMS A PART OF THIS POLICY . <br /> <br />EMPLOYER <br /> <br />_ A.S TO FORM <br />A.P:R~ . <br />~ ;~ <br />ra SheedY <br />).. CtY Attorney <br />Deputy I <br /> <br />, <br /> <br />VoG"lL Mn soer En F OF:ANGE COlHHY <br />90"' I~ MA H~ ST <br />st'l~-.!T;I flr'~!~ Cf"-\ 9~~701 <br /> <br />~I@Gclf~1 <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 10262(REV.5-01) <br />