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CERTHOLDER COPY SP <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 02 -14 -2008 GROUP: <br />POLICY NUMBER: 1610814 -2006 <br />CERTIFICATE ID: 76 <br />CERTIFICATE EXPIRES: 03 -28 -2007 <br />03 -28- 2008/03 -28 -2007 <br />CITY OF SANTA ANA SP JOB:ALL CALIFORNIA OPERATIONS <br />ATTN: MIKE LINARES ESQ -CDA <br />PO BOX 1988 M -25 <br />SANTA ANA CA 92705 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated <br />This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. <br />We will also give you 30days advance notice should this policy be cancelled prior to its normal expiration <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />=1ORIZE1REP4RE/SENTAT41iij PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03 -28 -2006 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />WOMEN'S TRANSITIONAL LIVING CENTER, INC SP <br />PO BOX 8103 <br />ORANGE CA 92863 <br />[SLC,SPj <br />4REV.2-05) PRINTED : 02 -14 -2008 <br />