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CERI i i'OLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />COMP6N5ATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07 -17 -2006 GROUP: <br />POLICY NUMBER 1768237 -2005 <br />CERTIFICATE ID: 5 <br />CERTIFICATE EXPIRES: 11 -11 -2008 <br />11 -11- 2005/11 -11 -2008 <br />CITY OF SANTA ANA NF <br />COMMUNITY DEVELOPMENT AGENCY -111-26 <br />PO BOX 1888 <br />SANTA ANA CA 62702 -1888 <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 />THORIZED REPRESENTATI PRESIDENT <br />� <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER (OCCURRENCE. <br />ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11 -11 -2004 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />REBUILDING TOGETHER ORANGE COUNTY (A NF <br />NON- PROFIT PUBLIC BENEFIT CORP ) ,. <br />PO BOX 329 <br />TUSTIN CA 82781 <br />jJD4,CNI <br />IREV.Y -551 PRINTED : 07 -17 -2008 <br />L'19 <br />