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r 06/29/7006 14:24 714-567-7474 OC HUMAN RELATIONS PACE Gl <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807. SAN r-aANCISCO,cA 94142-0807 <br />COMPENS/(TIPN <br />IN9VRANCE <br />FUND CERTIFtCAr>: OF WORKERS' COMPENSATION RYSURANCE <br />issue DAre: oe-»-aooe CiiOUP: . <br /> POLICY NIN~IBER: 1375218-2009 <br /> CEfaTe=KATE ID; 2B <br /> CERTIFlCATE EXPIRES: 10-01-2000 <br /> .10-01^2005]10-01-1000 ~' <br /> THIS CERTIFICATE SUPERSEOE5 Arm CORRECTS <br /> CERTTFTCA7E / 2A DATEO 0E-22-2005 <br />CITY OF SANTA ANA SP JDB:DISPUTE RESOLUTION PROGRAM <br />1D CIVIC CENTER PLZ M-57 <br />SANTA AMA CA 92701-4055 . <br />This Is to certify thrt we have Isswd + vdid Workers' Compansatlon inatratce pollry in a form approved by the <br />Celitornie ktstxanca Commissioner fe the employer named below for tho policy period Indicated <br />n,e policy is net subj+ct t0 caneelladon by the Pund except' upon 10 days adv+nOe written notice to the employer, <br />we will also gWe you f0 days advance notice should this policy be caneellad prig to Its normal expiration. <br />This certificate Of insurance IS net en insurance DOlicy and does~not amend, oxtand Or alter the covara9e afforded <br />wt~reipa~} tlo which rtehils ~COfrtifi~,+ie ne} gns~~cesmay 6a Issu~oor m ~ICh Oi any convect or otlrer document <br />r rll+y pertain, thB Inauran Ca <br />afforded by the policy described herein Is subject t0 aH the terms, exclusions, and condlelens, of such policy. <br />tZED REPRESENTATI ~ PRE <br />EMPLOYER'S LIASILTTY LIMT7 TNCLUDINB DEFENSE COSTS: ~~~~ <br />51,000,000 PER OCgIRRENCE. <br />=- <br />EMPLOYER <br />ORANGE COUNTY IRMNN RELATIONS COUNCIL (A 5P <br />lapfa-PROFIT CORPORATION) C/0 COUNCIL <br />730p S [+Rgr1O AVE $TE 5 <br />SMfTA ANA CA 92705 <br />SP <br />[$JW,CNI <br />IREV.s-osl PRINTED OS-13-2008 <br />