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<br />POLICYHOLDER COPY <br />STATE RC BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INS U R AN CS <br />FUND CERTIFICATE OF WORKERS' CONIPENSATION INSURANCE <br />ISSUE DATE: 02-07-2006 <br />;ITY OF SANTA ANA <br />!0 CIVIC CENTER PLAZA N36 <br />iANTA ANA CA 92701 <br />SG <br />GRCUP: <br />PCLICY NUMBER: 0802847-2005 <br />CERTIFICATE iD: 247 <br />CERTIFICATE EXPIRES: 10-01-2006 <br />10-01-2005/10-01-2006 <br />his is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />aiifornia insurance Commissioner to the employer named below fer the policy period indicated. <br />his policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. <br />Je will also give you 30days advance notice should this policy 'oe canceiled prior to its normal expiration. <br />tis certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />i the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />'ith respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />forded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />'THhORIZEO REPRESENTATI PRESIDE:V? <br />PLOVER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />OORSEMENT #1500 - JAMES K. CAIN PRESIDENT - EXCLUDED. <br />)ORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-1993 IS <br />-ACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />yL <br />70 <br />SG <br />jCCCLV!