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• CERTHOLDER COPY Sp <br />r RECEIVED MAY 25 1006 <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: OB-Oi-2008 GROUP: <br />POLICY NUMBER: 1801309-2008 <br />CERTIFICATE ID: 1 <br />-CERTIFICATE EXPIRES: 08-01-2007 <br />OB-01-2008/08-07-2007 <br />CITY OF SANTA ANA SP <br />COMMUNITY DEVELOPMENT AGENCY M-25 <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 />~~ <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: E1,000, 000 PER OCCURRENCE. <br /> <br />EMPLOYER <br />ASSISTANCE LEAGUE OF SANTA ANA SP <br />1037 W 1ST ST <br />SANTA ANA CA 92703 <br />M0408 <br />IREV.2-051 /~ a PRINTED 05-17-2006 <br />