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STATE <br />COMPENSATION <br />IN SIJRANCE <br />FUND <br />~~~ ~~ ~ ~ ~~ IN REPLY REFER T0: <br />OCTOBER 24, 2007 <br />C~ i ~', ,.`', A~~~ <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 WITHDRAWAL NOTICE <br />------------------------------ <br />RE: CERTIFICATE DATED SEPTEMBER 27, 2007 <br />THE CANCELLATION HAS BEEN WITHDRAWN FOR THE WORKERS' COMPENSATION <br />INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW. THIS LETTER SUPERSEDES <br />THE NOTICE OF CANCELLATION SENT TO YOU ON OCTOBER 19, 2007. <br />THIS EMPLOYER'S WORKERS' COMPENSATION INSURANCE COVERAGE CONTINUED <br />UNINTERRUPTED. <br />REP 03 <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 />