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CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />I N S U R A N C E <br />F U N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-01-2008 GROUP: <br />POLICY NUMBER: 1476908-2008 <br />CERTIFICATE ID: 178 <br />CERTIFICATE EXPIRES: 04-01-2009 <br />04-01-2008/04-01-2009 <br />CITY OF SANTA ANA SK I ~ ~O ~ ~ "' / <br />220 S DAISY AVE ~+~ <br />SANTA ANA CA 92703-4334 ~./Q (p <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: $1,000,000 PER OCCURRENCE. <br /> <br /> <br /> <br />~~, <br />EMPLOYER <br />HARPER & ASSOCIATES, INC. <br />1240 E ONTARIO AVE # D-2-312 # D-2-312 <br />CORONA CA 92881 <br />SK <br />PRINTED 03-18-2008 <br />SK <br />M0408 <br />(REV.2-05) <br />