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<br />STATE <br />COMPE;N$ATIOI>I <br />IN$U,,/o'I>ICIE <br />FUND <br /> <br />A sc <br />~ ~' · -200-Z -/tJS-2~ <br />P.O. BOX B07, SAN FRANCISCO,CA 94101-0807 <br /> <br />CERTIFICATE elF WORKERS' COMPENSATIClNINSURANCE <br /> <br />ISSUE DATE: 07-01-02 <br /> <br />POLICY NUMBER: 0843808 - 02 <br />CERTIFICATE EXPIRES: 07-01-03 <br /> <br />- <br /> <br />- <br /> <br />CHY OF SANTA ANA <br />CDBG. PROGRAM <br />P.O. BOX 1988 <br />SANTA ANA CA 92]01 <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' advance written 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 certific;ate of)nsurane.eis 110t an insur~nce policy and does not amend, extend or alter the coverage afforded <br />by the policies listed herein~~o'twithstanding anYJequir@Jnfilnt. term, or conditio!" of any contract or other document <br />with respect to which this certificate of inSurance maybe j;ssued or may pertain. the insurance afforded by the <br />policies described herein is sUbject to all ttle terms. exchJsions and conditions of such policies. <br /> <br />~IDE~ <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $'.ooQ,Ooo.OO PJ'R.DcplRREI>ICE. <br /> <br />ENDO!lSEMENT. #2085 ENTITLI'D CERTIFICATE HOLDERS' NDT.ICE EFFECTIVE 07/01/02 IS ATTACHED TO AND <br />FDRMS A PART OF THIS PDLICY. <br /> <br />Al'I'IHIV LU <br /> <br />~.. <br /> <br /> <br />DC'l1ut}:C\I.\ ,\U' 'i":' <br /> <br />1(-} '-\)i<;\ <br /> <br />_,~~.__~,'~._n <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />MEXICAN AMERICAN DPPDRTUNITY FDUN. <br />CLAUDIA GUTIERREZfRUF1ND <br />401 N GARFIELD AVE <br />MONTEBELLD CA 80840 <br /> <br />JolEIIICAI>I A/lIE!llCAN QPPORTUNITY FOUNDATIOI>I <br />(A NON-PRO~IT CO"".) <br /> <br />08CI7-02 <br /> <br />P040e <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 10265 (REV 201) <br /> <br />PRINTED: <br />