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<br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />-~ \ <br />t.YJ}-1 <br />) 0,' ,'I <br />'_/_~I~'W 0 /C/ <br />f/ 4' l <br /> <br />IN REPLY REFER TO: <br /> <br />APRIL 13, 2006 <br /> <br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES <br />AGENTS, AND REPRESENTATIVES <br />60 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />CERTIFICATE OF WORKERS' <br /> <br />COMPENSATION INSURANCE <br /> <br />CANCELLATION NOTICE <br /> <br />RE: CERTIFICATE DATED APRIL 26, 2005 <br /> <br />THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER <br /> <br />NAMED BELOW HAS BEEN CANCELLED EFFECTIVE FEBRUARY 12, 2006 AT <br />12:01 A.M. <br /> <br />IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE <br />CONTACT THE EMPLOYER NAMED BELOW <br /> <br />EMPLOYER: <br /> <br />IMAGE IV SYSTEMS INC <br />512 S VARNEY ST <br />BURBANK, CA 91502 <br />POLICY 1577125-05 <br /> <br />CUSTOMER SERVICE REPRESENTATIVE <br />CUSTOMER SERVICE CENTER <br />(877) 405-4545 <br /> <br />1275 Market Street. San Francisco. CA 94103- 1410 <br />Mailing Address: P.O. Box 420807. San Francisco, CA 94142-0807 <br /> <br />selF 19102 <br />