MARIPOSA WOMEN'S CENTER 4 - 2002

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:-' ... A ~ ZO::J,;)-- J os- ~ c?S5P STATE COMPENSATION INS U A A N C.E FUND "-' P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 '-" CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-02 POLICY NUMBER: 4119-02 UNIT 000111411 CERTIFICATE EXPIRES: 07-01-03 CITY OF SANTA ANA COMMUN lTY DEV. AGENCY M-25-00R I S A TURLEY P .0. BOX 1 988 SANTA ANA CALIFORNIA 92102-1988 ~O': ALL OPERATIONS This is to certify that we have issued a valid Workers' Compensation insurance pOlicy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days'-advan~e notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amen~ extend or alter the cOl/erag~ afforded by the polictes Iisled herein._!\Iotwithstan~ing any requirement, term, or cc>ndition of any contract or other document with respect to which this certificate ofdnsurancemay, b:ei"sued or maypert:ain~- the insurance afforded by the policies described herein is subject to aU the term~, excfysions and conditions of such policies. y ,.,/ ~ ~:'sIDENT EMPLOYER'S LIABIL~T" L~MIT INCLUOING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #20115 ENTIT~ED CERTIFICATE HOLOERS' NOTICE EFFECTIVE 07/01/02 IS ATTACHEO TO AND FORMS A PART DF THIS POL~CY. AP'I::)\ TO FOR~d ,", , I ,. f-', ,1 ,-"'V" - EMPLOYER LEGAL NAME MARIPOSA WOMEN'S CENTER, INC. 812 W TOWN AND COllNTRy: RO ORANGE CA 928118 MARIPOSA WOMEN'S CENTER, INC. (A NON-PROFIT CORP.) .. :