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<br />NOV 07; 2,(102 <br /> <br />11 : 25 AM <br /> <br />FROM: 7149971994 <br /> <br />rt- L.UUI ...UlC'~. <br />1 PAGE 2 <br />'wi ' <br /> <br />'-' <br /> <br />CERTIFICATE HOLDER COPY <br /> <br />STATE P.o. BOX 420807. SAN FRANCISCO, CA 94142.0807 <br />COMPENSATION <br />INSURANCE <br /> <br />FUN 0 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />NOVEMBER 7. 2002 <br /> <br />GROUP: 000488 <br />POLICY NUMBER: 679-2002 <br />CERTIFICATE 10: 2 <br />CERTIFICATE EXPIRES: 08-15-2003 <br />08-15-2002108-15-2003 <br /> <br />CITY OF SANTA ANA CO}~NITY <br />DEVELOPMENT AGENCY M-25 <br />P.O. BOX 1988 <br />SANTA ANA. CA 92702-1988 <br /> <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />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 10 the employer. <br /> <br />We \ViII also give you 30 days advance notice should this policy be cancelled prior 10 its normal expiration. <br /> <br />This certificate of insurance is not an insurance policy and does not amend, extend or aller the coverage afforded by the <br />polidas listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certifICate of insurance may be issued or may pertain, the insurance afforded by Ihe policies <br />described herein is subject to all the tenms. exclusions. and conditions. of such pOlicies. <br /> <br />~ <br /> <br /> <br />I{~ <br /> <br />PRES DENT <br /> <br />AUTliOAIZED REPRESENTATIVE <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDI~G DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-15-2002 IS <br />ATTACHED TO AND FORMS A PART OF THTS POLICY. <br /> <br />ru d<.OYbD AS 1U d.h,. . <br /> <br />L~:/d) <br /> <br />Deputy City Attorney <br /> <br />EMPLOVER <br /> <br />WlSEPLACE. A CA CORP <br />1411 N BROADW.~ Y <br />