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<br />STATE <br />COMPENSATION <br />INSURANCE <br />FuNo <br />AUGUST 2, 2007 <br />CLERK OF THE CITY COUNCIL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M-30 <br />SANTA ANA CA 92701-4058 <br />IN REPLY REFER TO: <br />CERTIFICATE OF WORKERS' <br />----------------------- <br />COMPENSATION INSURANCE <br />---------------------- <br />CANCELLATION/CONVERSION NOTICE <br />------------------------------ <br />RE: CERTIFICATE DATED APRIL 13, 2007 <br />THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE <br />POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY <br />EFFECTIVE JULY 1, 2007. THE NEW POLICY WILL PROVIDE <br />UNINTERRUPTED COVERAGE. <br />YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER <br />THE NEW POLICY NUMBER: 567-0001087-07. <br />IF YOU HAVE ANY QUESTION5, PLEASE CONTACT THE CUSTOMER <br />SERVICES UNIT AT THE NUMBER LISTED BELOW. <br />EMPLOYER: <br />ARC MID-CITIES <br />14208 TOWNE AVE <br />LOS ANGELES, CA 90061 <br />POLICX 1833542-06 <br />CUSTOMER SERVICES UNIT <br />LOS ANGELES DISTRICT OFFICE <br />(323) 266-5000 <br />1275 Market Street • San Francisco, CA 94103- 1410 <br />Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807 <br /> <br />~, ,~~o <br />N~~' <br />SCIF 19102 <br />