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CERTNOLDER Cf1-Y SIP <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: 01-01-2006 GROUP: <br />POLICY NUMBER: 1528845-2006 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 01-01-2007 <br />01-01-2006/01-01-2007 <br />CITY OF SANTA ANA SP <br />COMMUNITY DEVELOPMENT AGENCY (M-2S) <br />PO BOX 1988 <br />SANTA ANA CA 92702 <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 upon 10 days advance written notice to the employer. <br />We will also give you 10 days 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 />Ate_ c . <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br />PP ROVED AS T6 I'UPtm <br />EMPLOYER <br />_ecru r<tt SY,ec,dy <br />.`al+al City Atto-:ey <br />ORANGE COUNTY ON TRACK SIP <br />PO BOX 4141 <br />TUSTIN CA 92781 <br />M0408 <br />laev.z-osl /' k PRINTED 12-17-2005 <br />