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<br />J'1 0B:54P FROM: <br /> <br />TD:5714235 <br />POLICVHOLOER COPY <br /> <br />STATE <br />COUP.HSATION <br />INSU"ANCE <br />FUND <br /> <br />P.O. BOX 420B07, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 04-14-2006 <br /> <br />GROUP: <br />POLICY NUMBER; 1786151-2006 <br />CERTIFICATE ID: 4 <br />CERTIFICATE EXPIRES, 04-14-2007 <br />04-14-2008/04-'4-200' <br /> <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA CA 82702 <br /> <br />SP <br /> <br />This is to certify thilt we nave issued a v.atid Workers' Compens;tion insur.anca policy in iI form i1pproved by the <br />California insurance Commissioner to the employer named below for the poliCY periOd indicated. <br /> <br />This policy is not subject to ~nc811i1tion by the Fund except upon 10 days advmlce written notice to tile emplover. <br /> <br />We will also give you 10 days advance notice should this poliCY be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance policv and does not amend. extend or alter the coverage afforded <br />by the policy listed herein. Notwithstlndin~ any requirement. term or condition of any contract or otner document <br />with respect to whlch this certificate of Insurance may be i$l:ued or to which it may P8'rt_n, the in$uranc~ <br />affordad bV the polic\I descriDed herein is subject to all the terms. exclusions, and conditions. of such policy. <br /> <br />6::~P~ <br /> <br />~ <br /> <br />PRESIDENT <br />$ 1 . 000. 000 PER OCCURRENCE. <br /> <br />EMPLOyeR'S LIABILITV lIMIT INCLUDING OEFENSE COSTS: <br /> <br />EW'LQ.~ER--~. - <br />~- <br /> <br />.J <br />> <br />. \~;'>;"/' {);/ <br />, L-[~:~, <br /> <br />,.~~c., ) <br />",' " 0{ <br />l~ "t <br /> <br />- .~"M~ <br /> <br />.. ~--... <br /> <br />.~\ <br /> <br /> <br />ORANGE COUNTY CHILDREN'S THERAPEUTC ARTS SP/ <br />208 N BROADWAY :/ <br />SANTA ANA CA 92701 <br /> <br /> <br />PRINTEO <br /> <br />03-18-2006 <br /> <br /> <br />P.2 <br /> <br />S. <br /> <br />M040a <br />