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<br />'W <br /> <br />'wi <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142.0807 <br />COMPQN~A1"ON <br />INSURANCE <br />FUN D CERTIFICATE QF WORI<ERS' COMPENSATlOIllINSURANCE <br /> <br />OCTOBER 25, 2002 <br /> <br />POLICY NUMBER: 1462781 - 02 <br />CERTIFICATE EXPIRES: 10-1-03 <br /> <br />,- <br /> <br />CITY OF SANTA 'ANA <br />CO~l'lUNHY DEVELOPl'lENT <br />PO BOX 1988 1'1-25 <br />SANT A A!\IA CA 9Z70? <br /> <br />AGENCY <br /> <br />L <br /> <br />ThiS IS to certity that we have iSl;ued a valid Workers', C9mj'len$'lltionin$urance Policy in a form approved by theCalifomia <br />Insurance Commissioner to the-employer"amedoelow farihe"pol i-cy-period indicated. - ,__ <br /> <br />This policy IS not subject to cancellation by the Fund except upon ~ days' advance written notice to the employer. <br /> <br />We will also give you ~~Nd'lys'~dV~nc; notic" sh.pold this polley be cancelled prior to its h9rmal expiratiOn. <br /> <br />This certific"te 0\ insurance is not <In insurance policy and <lOes nqt amerl~, extenefoc aijer the coverage afforded by the <br />poliCies listed her"in. Notwithsta~<lingaryreqUirern,,~t. term, or condition plan,. contrap! or other do~umen! Wlt~ <br />respect to which this certificate of insurance m,ylj'e.i!oT~Becj or may pertain, the insurance afforded by; the pOlicies <br />described herein is subject to all the terms, extlusionsand condltions of l;uch politiel;. <br />. <br /> <br />/7~~~ <br /> <br />AUTHORtZEDREPRESENTATlVE ., <br /> <br />K~ <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILITY ~Il'lr;T Ii'CLlJDING DEFENGE CO~TS: $1,000,000 PEl'< OCCURRENCE~ <br /> <br />ENDORSEI1ENT 112065 ENTITLED CERTlnCATE HOLDERS'NOTICE EFFECTIVE <br />10/25/02 IS ATTACHED TO AND FPRl'lS A PAlll OF THIS POLtey. <br /> <br />-, <br /> <br />EMPLOYER <br /> <br /> <br />. APPRPVEP AS TO FORM <br /> <br />ut~O~1 <br /> <br />Doputy City Altorn y <br /> <br />,- <br /> <br />..~ <br /> <br />1d0l'lEN HELPI'NG 1d0MEN : . <br />A NON-PROFIT PUBLIC BENEFIT ~CORP, <br />711 ill 17TH ST STE fltO <br />COSTA l'lESA CA 92627 <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SC" 10262 ,REV 5.", <br /> <br />"'~lt7~i <br />