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<br />MAY,15,2006 lO:40A <br /> <br />9516985436 <br /> <br />. <br /> <br />. <br /> <br />POLICYHOLOER COPY <br /> <br />page 2 <br />51< <br /> <br />STATE <br />COMPI!NSATION <br />INSU,.AHCE <br />FUND <br /> <br />P,Q BOX 420807, SAN FRANCISCQ,CA 94142-0607 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 02-07-2 6 <br /> <br />G~OUP: oo022B <br />POLICY NUM8Ell: 0027195-200& <br />CERTIFICATE 10: 22 <br />CERTIFICATE E;(f'IRES: 02-07 -2007 <br />02-0~'-200B/02-07 ~2007 <br /> <br />CITY OF SANTA ANA <br />ATTN: SHARON HEn, URCHASIIlG <br />20 CIVIC CENTER PL A-PMB HIB8 <br />SANTA ANA CA 92702 <br /> <br />51< <br /> <br />This i$ to certify th.at w have is sLed I valid Workers' CompeMatian inSl.lrance policy in .II form approved bv t 6 <br />California Insur.mce Com is!lionElr to the employer named below for the ~or;cy perioc indicated. <br /> <br />This QQlicy is not sub je t to cancellation by the Fund exeept upon 30 dlYs advance written nolll;:e to the em pi yer. <br /> <br />We will also give you 3 days Bc:!v;lnc. notice should this policy be cancelled prior te its nermal ex~ir.ation. <br /> <br />Tni!i certific.ete of insura ce is. not an in$,urance policy and does not am.,nd, extend cr .alter the coval"OIQe .affor ad <br />bv the policy lis.ted here,' Nolwithstandin~ any requirement, Itrm or condilion of any contract or other docum t <br />with respect to which 1 IS certific;.ta of insurance! may be Issued Or lo which it may Pertain. the insurance <br />affordad by the policy d scribed h/!rein is subject to all the terms, 8Xclu!l:ions, and tmnditions. of suc:h policy. <br /> <br />~ ~_. <br /> <br />~THORIZED REP~ES NTATI ) PRESIDENT <br />UNLESS INDICATfO OT ERWISE ~Y ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FDLLD lNG, <br />THOSE NAMED IN THE OLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE E LDYER; <br />EMPLDVEES COVERED D A CONP~EHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFDRDING <br />CALIFDRNIA WORKERS' COMPENS'TION BENEFITS; EMPLOYEES EXCLUDED UNOER CALIFDRNIA WORKERS' <br />COMPENSATIDN LAW. <br /> <br />EMPLOYER'S LIA9ILIT LIMIT INCLUOINQ DEFENSE COSTS, $1,000,000 PER OCCURRENCE. <br /> <br />ENOORSEMENT #2095 E TITLED CORTIFICATO HOLDERS' NOTICE EFFECTIVE D2-07-2005 IS <br />ATTACHED TO AND FOR S A PART OF THIS POLICY, <br /> <br />~~...... <br /> <br />, , <br /> <br />EMPLOYER <br /> <br />.JONES. EARL DOYLE 0 ~ONE~. CHARLHN WIlEY <br />DBA: PACInC SYSTEM ELECTRIl: <br />38330 VIA LA PALOMA <br />MURRIETA CA B25B3 <br /> <br />(REV.2'051 <br /> <br />PRJNTED 01-20-2008 <br /> <br />N04'0 <br /> <br />