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POLICYHOLDER COPY 5L <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 CERTlF1CATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-10-2007 GROUP: <br />POLICY NUMBER: 1414076-2006 <br />CERTIFICATE ID: 92 <br />CERTIFICATE EXPIRES: 12-01-2007 <br />12-01-2008/12-01-2007 <br />CITY OF SANTA ANA SL <br />CLERK OF THE CITY COUNCIL <br />20 CIVIC CENFER PLZ M-30 <br />SANTA ANA CA 92701-4058 <br />ihis is to certify that we have issued a valid Workers' Compensation insurance policy in a form approued by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation 6y the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate o1 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 aN the terms, exclusions, and conditions, of such policy. <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 41,000,000 PER OCCURRENCE, <br />ENDORSEMENT /!1600 -GERALD NEWFARMFR PRES CEO SEC - EXCLUDED. <br />ENDORSEMENT k2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-2002 IS <br />----ATTACHED TO ANO FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />MANAGEMENT PARTNERS, INC SL <br />1730 MADISON RD <br />CINCINNATI OH 45206 <br />~a~v.ros <br />'~ . <br />~~ <br />~J <br />~, <br />s <br />" s: ~~ ICJ <br />~l ~~ <br />err ~~ <br />~r„ <br />cy <br />(JC1,SCj <br />PRINTED 01-10-2007 <br />