|
<br />::~.:~.:t.:,.':t.'.:;//~~.~t:',?:,::)\~,~~':~:'f~~5l.\t~}:"~;-;~2~ji\';~:~:'~~.'/"::';~::~'~";:' '_'J, ,. ~..,. v' ". .'.., \:,-~..". I" ". ~Jf~" '.n "",_
<br />X",> S:,.; . " , ,,//.- .. .'. .' .';":"';:e;:"~t;'~:1;:'~ff;::.~.~,!:~'~~;;~:t.1;'0K~1;~~~
<br />:(;': -S(fAT.:L~i:,p:o.~'80t:SAN FRANCisco,CA 9410 1-0a07,>;<:-.};.,;,<:( - .. <F~,,',,;:. '1
<br />< COMPEN'SA"T:ION \, '""":. '-;J '/' '~;..~' ;:",~" :~_. -,""". '~ ,,.. _
<br />INS U RAN o'e Be,', "':'~:i'" \ ; (
<br />F U'N ,0 CERTIFICATE OF,WORKERSi'COMPENSATIOI\IIN;URANCE
<br />1.",,0" r:i :~.~ . ':'. ,'~~ --.
<br />,
<br />, POLICY NUMBER: 1209902 - 02
<br />ISSUE .DATE: 10-01-02 CERTIFICATE EXPIRES: 10-01-03
<br />
<br />C.ITY OF SANTA ANA
<br />COMMUNITY'DEVELOPMENT AGENCY /1-25
<br />POBOX 1988 ATTN JOHN,MALONEY
<br />SANTA ANA CA 92702
<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'adva,.,ce notice should this policy be cancelled prior to its normal expiration.
<br />
<br />This certifi~ate:~bf;'inslir:.~ric:e _ is,nat_an i~surance policy and does not amend. extend' or alter_ the.,co~e'rag~ "afforded
<br />by the poJicjes'li~ted herei~~_:J"otwithstanding anv.,-f.e_quire_/'lI4:!nt. term. or condition of any contra,cLer ether docurT!enL_.
<br />with respect to Which this certificate of irisurarice may. be ;i,ssued or may 'pertain,,-'the insurance afforded ;bv. the'
<br />policies de:scribed herein is subject to all ~he t~rnis. exclusiQns and conditions of such policies.
<br />o ' " ,;.- ".
<br />
<br />. .~/' ,~.
<br />
<br />~ /1>/7 1/i/
<br />";.'L4'~
<br />...... ;" ',PRESIDENT
<br />
<br />, ,,' .
<br />r EM~LOVE~.'\LIABI~IT)' L'IM,IT INCLUDING DEFENSE CD~TS: $rOOO.Oll~.OO P~RlCF~RENCE.
<br />
<br />"ENDoRSEMENT"'206S '~NTI1rL~DCERTIFICATE HOLDERS' 'NOTICE EFFECTIVE'"10/01/02: IS ATTACHED .TO AND
<br />FORMS A PART 'OF' THIS poqCY 0;' . ... ", "- 'i .... , , .
<br />
<br />
<br />APPROVED AS]O FORl'vi
<br />
<br />):~;.~7
<br />
<br />Deputy C:ry J\ttorne'y
<br />
<br />LEGAL NAME
<br />
<br />EMPLOYER
<br />
<br />"
<br />
<br />MERCY,HOUSE TRANSITIONAL LIVING
<br />CENTERS f
<br />PO BOX 1905. i . "
<br />SANTA ANA CA'92702
<br />
<br />
<br />MERCV, HOUSE'. TRANSITIONAL ,LIVING CENTERS
<br />(A NON-PROFIT'ORG, h' .. ..... ,., "
<br />,,;;~~~;~'~~~_f~~~~j --:,~;>--:' :'~/;.,;_/ .,;' ,.:- :~::i<'.~~~~,;'.~:~~>:~;-, -.
<br />".,~, -<
<br />
<br />
<br />; . .' '.. . i' . '. ...<, ;";;'6::r~;02/
<br />1':ilillf'~IJlfjl~~..:"l-~~,j;t:l{.j=lIit,~.~:t~',~'I:ro~~<~<;i.~:'~~~~'~jl~" :i~;~~I;~~J:.~
<br />
|