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<br />". : COMPENSATION '\~~,_ _ ," >1 .,: - . - - - i ...- - - '-;^~'~~<';~' .;; . . -,". . ,-';~;!;:~~.;<~~.',~,:</'.-t
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<br />INS U 1'\ II< N C'E " .,' > ,. J I
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<br />FUN ,0 CERTIFICATE QF! WOkKERifpQMPENSATlO~ \IN~URANCE
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<br />ISSUEDA TE,
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<br />10-01-02
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<br />POLICY NUMBER 1209902 - 02
<br />CERTIFICATE EXPIRES, 10-01-03
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<br />CITY OF SANTA ANA
<br />COMMUN ITY' DEVELOPMENT AGENCY M-25
<br />POBOX 1988 ATTN JOHN'~ALONEY
<br />SANTA ANA CA 92702
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<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.
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<br />This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer.
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<br />We will also give you__ 30 days' advarlce notice should this policy be cancelled prior to its normal -expiration.
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<br />This cer.tific;:ate:~off-tnsllrAanc:eis "ot~n insurance policy and does not amend, extend or alter__tlle.,coverageafforded
<br />by the P9Iicie~-' li$ted herei(L~, Nqtwithstandirl."g any r.e,quirer:n.i!nt. term, or condition ~f any contract ,or' other d.pcumenL
<br />with resp-~ct}o.which this c'ertificate of irisuraqce,_,may. pe '-i~sued or may pertain" the Insurance afforded~by' the)
<br />policies described herein is subject to all the t(lrms, exclusions and conditions of such policies.
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<br />" PRESIDENT .. .
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<br />EMPLOXE~'~ LIABILITY LIMIT INCLUDING DEFENSE COSTS: $l~QOO;OOO.OO P~Rlbcqu~RENCE.
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<br />'ENDORSEMENT"'2065 'ENTI~'rL.~DCERTIFIC.ATE HOLDERS' NOTICE EFFECTIVE '10/01/02 IS 'ATi/l.giEDTO AND
<br />FORMS A PART 'OF THIS poqCY.' , "'" \; ..' ~
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<br />APPROVED AS
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<br />}:a raSheedy
<br />Do:rl:l} C:t~!A:ttorney
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<br />10 FORNI
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<br />EMPLOYER
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<br />LEGAL NAME
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<br />MERCY. HOUSE TRANSITIONAL
<br />CENTERS ;
<br />PO BOX 1905 . ..... '
<br />SANTA ANA CA'92702
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<br />MERCY HOUSE;.T~A/'lS;TIONAL LIVING CENTERS
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