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<br />~ 07/11/2006 08:53 FAX <br /> <br />I4J 002,/002 <br /> <br />, <br />. <br /> <br />CERTHOLDER COpy <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANce <br />FUND <br /> <br />P.O, BOX 420807, SAN FRANCISCO,CA 94142.-0807 <br /> <br />CERTIFICA TE OF WORKERS' COMPENSATION 'NSURANCE <br /> <br />ISSUE DATE: 04-01-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 1:)54937-2006 <br />CEHTlFICA 1'E: tb: 39 <br />CElnlflCATE EXPIRES: 04-01-2007 <br />04-01-'006/04-01-2007 <br /> <br />CITY oy SAN1A ANA <br />COMMUNITY OfVELOPMENT <br />20 C!VtC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />SP <br /> <br />Tn;!> I~. 10 (:p.r:lly thaI Wfl h.l"'~ Is:;u~)d " ""Iit1 'Norkers' ComPAn~.alin" Insur.."cp. policy it'll form i1pprOIJ(.d lY-i tl'v; <br />C"lifof!'l;;l !n~ur.,,,(;(: COlYllw!;(;ioner to lh~ ~mplo'"p.r named belOW for th~ POitCI' Pllrlod Indicated. <br /> <br />'1'hl!. policV is not subjecl lo cancellation bv thl} Fund f~XClilP: u;!cn30 ~iav:; adVilrlCO ,^,I'ltt~!n notlCI,! if) UH, <:,...,pioyer <br /> <br />w~ \lvil! ;li:~o give 1'01) 30dl.l1'3 :.dwmCfl nolieI'! r.hould this policV l'~ cancelled prior to Itr. norrTlill CXIN;ltQ" <br /> <br />Th;~, cortitica:c Of inS\Jr.'lflce i(\ not an insurance pOlicy and doot; nol ;lm~n~, ~;xllmd or alll~f the cOvt,.;,~W oiI10rd.)d <br />bv Ihe poHr.:v li~ted herein. Notwllh:;;lilnd"..q ilOV req~Jirem~~f\l. IeI'm 0: cort(hlior' of any eon:.r,'ct or 01,.,,,, dncum(!'l'. <br />.~Ilh ref.p~!ci 1<) which thit; C;f,!rliticalp. 01 Insuranco mi)V PC '$tlued cr Le which Il mao; ~'o,l;)i(\. tl)(, ITI::-ur:.II'(',~ <br />a~for~'lEl(1 by the polzey dc:;crrbEld "Or(Wl is 5ut>;ecl \0 all the lorrn~, fJ"chl:1I0"S. .lnd conditu:m:;, of ~\K:h :'OdC';', <br /> <br /> <br />~... <br /> <br />PRf.SIDENT <br /> <br />~MPLOVER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS; $1.000.000 PER OCCURRENCE. <br /> <br />ENOQRSEMENT #2065 ENTITLED CERTIFICATE ~LOERS' NOYICE EFFECTIVE 04~01~2003 IS <br />ATTACHED TO AND FORMS A PART OF TH1$ POLICY. <br /> <br />.'\ P <br />, -:,), <br /> <br />:,I <br /> <br />1\S TO FOg}v1 <br /> <br />[MPI..OV[i=l <br /> <br />-_......._~ <br /> <br />~Lf~ (,;; -U'~;;~y._~---_._- <br />'''J.{;::t.::~, l~ C';ty /~ ttc <br />,\_, y <br /> <br />ORANGE COUNTY ASSOCIATION FOR MENTAL HEALTH <br />822 W TOWN AND COUNTRY RD <br />ORANGE CA 92868 <br /> <br />;r~t:v,z.'~)r~) <br /> <br />c.t <br /> <br />PRl;NTEO <br /> <br />If' J\R C:7; I <br />03-18-2006 <br /> <br />M0411 <br />