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CERTHOLDER Cr -y <br />'%11 <br />%*We <br />TE P.O. BOX 420807, SAN FRANCiSCO,CA 94142--0807 <br />isuRANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 00-01-2005 GROUP: �Y <br />POLICY NUM90h 1028422-2005 <br />CERTIFICATE ID: 9 r <br />CERTIFICATE EXPIRES: 09-01-2006 <br />08-01-2005/09-01-2000 <br />CITY OF SARA ANA NA <br />ATTN CHRISTINE CALDERON - TRESURY MANAGER <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92791 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California lbsurance Commissioner to the employer named below for the policy peeled indicated <br />This policy is not subject to cancellation by the Fund except upon SQ days advance written notice to the amployor. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This cartificato of insurance is not an insurance policy and does net amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirern*ne iterm <br />er door Conditto ion <br />t may of any conpertract <br />tor ,nth other <br />acumen <br />with rospect to which this certificate of insurance may <br />cg <br />afforded by the policy described herein is subject to all the 't@i-ms, exclusions, and conditions, of such policy. <br />YA44 . e— 1,, e • <br />N.,� <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYEReS LIABILITY LIMIT INCLUDING DEFENSE COSTS: Sl,0oo,00o PER OCCURRENCE. <br />ENDORSEMENT #1800 - DONALD H MAYNOR, SECRETARY TREAS - FXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-1992 IS <br />.� ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />DONALD H. NAYNOR A PROFESSIONAL LAY! NA <br />CORPORATION <br />235 CATALPA DR <br />ATHERTON CA 04027 <br />RE V.2.05) <br />Z0 39vd VNd C1NGS .d0 A110 <br />140408 <br />PRINTED ; 08-17-3005 <br />rocG b9V U Z0:9Z 9007,/90/EO <br />