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<br />v ,( '''-I... "u, " ~., c' r r, fI <br /> <br />CERTHOLDER COPY <br /> <br />STATE <br />COMPI:NSATlON <br />INSURAwce <br />FUND <br /> <br />PH BO)( 4Z0B07, SAN FRANCISCQ,CA 941 42-0B07 <br /> <br />CERTlFICAT& OF WORKERS' COMPENSATION INSURANce <br /> <br />lSSU~ DATe~ 01-10-2007 <br /> <br />GROUP: <br />POLICY NUM8~R, 1414076-200B <br />CER1IFICA TE ID: 92 <br />CE'RTIFICAT[; EXF'IFt~S; 12-0.-2007 <br />12~01-~ooa/12-0'-2007 <br /> <br />CITY OF SANT^ ~ <br />C~~RK Of THE CITY COUNCt~ <br />20 CiVIC O~NTER PL2 M-30 <br />SANTA ANA CA 92101-4068 <br /> <br />SL <br /> <br />7hJ! is to !;lllrtll\, thai ""10 hllve issuod I v,lid Work8r:s' Comflensslion insurance pclicy in I form .llpprov!!d by the <br />C,lilorni~ Insur,ncl! Commls"lllnOr 10 tn!! employer nllmetl below for the policy period Illdic<lle~. <br /> <br />Thj~ Jlalicv is: not s.ubjt'lct to ~a!.,cellatio!'l bV Ihe F",ncl except IJpon30 dIVE adv.:arlce written nptice to Ine lImplOyM. <br /> <br />We will ~I~o gillA you 30duys advpnce l10tice should thi~ policy bl!! cane~lled p,i....r to its normal ex~irallOr'l. <br /> <br />'J'nis: cerHficllle of In'Sl.Iranca I~ nOI ,In InlOur;nr;:e pulky ~d d01i!5 nat amend. extend or .altElr tho CQver;ge altotdtld <br />by the pOlio,; li~tpd hereill. Notwithstandinj any rl'lqUlrl'Jmtlr'lt, term or r;:QndlLlgn gf anv l:'ontrJCl or gt,",er Q"l;lcvmam <br />with ra~pecl Ie whleh this certificate of I'I!1Uralll;'" mal' be is;Jued or to whieh it mAY p"'(~il.ln, 1h6 insurlnc" <br />Dfford~d by thl! POllOI' d(l~cribec:l herein ilt subject to all the u"rms. e)C(lju~ions. and condition:!!. of suon l=>oHcy. <br /> <br /> <br />~ <br /> <br /> <br />THORIZii:O R'ePRESENT ATI PR~SIDENT <br /> <br />EMPLOYERIS LIABILITY LIMIT INCLUDING DEFENSE COSTSl Sf,OOO,OOO P~R OCCURRENCE. <br /> <br />eNCORSEM~NT #lSDO - GERALO NEWfARMER PRES CED SEe - ~XCLUDED. <br /> <br />ENDORSEMENT #20BB ENTIT~ED CERTIFICATE HOLDERS' NOTICE EFF!crrv~ 12-01w2002 IS <br />______ATTACHED To AND rORMS A PART OF THIS POLICV, <br /> <br />eMPLOYER <br /> <br />~ '.'/ <br />;::~-e.;~. <br />7: <br /> <br />.".--...-'" <br /> <br />MANAGEMENT PMTNERS. iNC <br />1730 MADISON Flb <br />CINC!~ATI OH 45208 <br /> <br />SL <br /> <br />PRINTED <br /> <br />[JC1.SCl <br />01.10-2007 <br /> <br />IflEIJ.:'OSI <br /> <br />Igj V\i Ii V'-'! <br /> <br />SL <br />