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<br />. <br /> <br />\.of <br /> <br />~ <br /> <br />~ SG <br />r -7-00L- IQJ - +(." <br /> <br />STATE P.O. BOX 807; SAN FRANCISCQ,CA 94101-0807 <br />COMPENSATIO..,. <br />IN SUI'tANCE <br />FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 0ll-01-02 <br /> <br />POLICY NUMBER: 0675401 - 02 <br />CERTIFICATE EXPIRES: 08-01-03 <br /> <br />Cl TY OF SANTA ANA <br />AtrN JOI1NMALONEY MGMT A I DE <br />POBOX 1988 <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' advance notice should this poltcy be cancelled pnor to its normal eXpiration. <br /> <br />This certificate ,ofinsunmc~_is_l1ot Sin insur~lnce policy and does not' am~_nd~ extend: or alter the caverag. afforded <br />by the polici~slisted herein;f\iotw,ithstanding anyr.~q~ir~ment. term. or condi1ial'l of any cantr~t prather dacumiE!nt <br />with respect to which this certificate of' in$uram;e~ rn,JliY1)e'"issued ar mayperq.in._"the insurance afforded ,bY the <br />policies described herein is sUbject to all the term~. excl~slons and conditions of such policies. <br /> <br /> <br />~IDE~ <br /> <br />EMP~OYER'S ~IA81~lTY ~IMlT INC~UDJNG DEFENSE COSTS: $1.000,000.00 PER 'OCCURRENCE. <br />ENDORSEMENT #2085 ENTlT~ED CERTIFICATE HD~DERS' NOTICE EI'FECTJVE08/01/02 J~ ATTACHED TO AND <br />FDRM~ A PARt DFtHJS po~tCY. <br /> <br />APPROVED AS TO FORM <br /> <br />~~O~ <br />ur~ Sheedy . · <br />I?eputy City Attorney <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />SHARE OUR SELVES <br />1550 SUPERIOR AVE <br />COSTA MESA CA 92627 <br /> <br />SHARE OURSELVES CORPORATION <br />(ANON-PROFitT CORP.j <br /> <br />07~ 17-02 <br /> <br />P0408 <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 102651REV 201) <br /> <br />PRINTED' <br />