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STATE <br />COMPENSATION <br />I N S U R A N C E <br />Fu ni v <br />OCTOBER 11, 2007 <br />~ ~~ r s ~ <br />QTY OF` v~~dTA AMA <br />E~ER~t c~= eov~ci~. <br />CITY CLERK OF THE CITY OF COUNCIL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M-30 <br />SANTA ANA CA 92701-4058 <br />CERTIFICATE OF WORKERS' <br />----------------------- <br />COMPENSATION INSURANCE <br />---------------------- <br />CANCELLATION NOTICE <br />------------------- <br />RE: CERTIFICATE DATED SEPTEMBER 27, 2007 <br />IN REPLY REFER TO: <br />THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER <br />NAMED BELOW HAS BEEN CANCELLED EFFECTIVE OCTOBER 25, 2007 AT <br />12:01 A.M. <br />IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE <br />CONTACT THE EMPLOYER NAMED BELOW <br />EMPLOYER: <br />ARC MID-CITIES <br />14208 TOWNE AVE <br />LOS ANGELES, CA 90061 <br />POLICY 567-0001087-07 <br />CUSTOMER SERVICES UNIT <br />LOS ANGELES DISTRICT OFFICE <br />(323) 266-5000 <br />1 275 Market Street • San Francisco, CA 94103- 1410 <br />Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807 <br />SCIF 19102 <br />