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:36p MAJOR LEAGUE SOFTBALL 8185599780 <br />P.I <br />CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />'":SVE DATE: t16-21-2007 GROUP: <br />POLICY NUMBER 1453432-2007 <br />CERTIFICATE ID; 44 <br />CERTIFICATE EXPIRES: 03-01-2008 <br />03-01-2007/03-01-2008 <br />CITY OF SANTA ANA <br />21 CIV:!C CENTER PL2 <br />c r•""t AW CA 92701-4058 <br />SC <br />-'^ certfy that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />C-i"o.^Ia 'rsurance Commissioner to the employer named below for the policy period indicated. <br />s,.bject to cancellation by the Fund except upon30 days advance written notice to the employer <br />e r. 1 &so Give you 30days advance notice should this policy be cancelled prior to its normal expiration. <br />Lois certifi"te of insurance is not an insurance policy and does not amend extend or after the coverage afforded <br />b„ the policy Lsted herein. Notwithstanding any requirement, term or condition of any contract or other document <br />-scec; to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />`_y the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />'\,.THORIZM REPRESENTATI PRESIDENT <br />T_-FL(.'"'ER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />--.-GAT #1600 - DAVID R JOHNSON PRES,SEC,T - EXCLUDED. <br />T'0:':.3EI0ENT 61600 - DAVID M SENNEM VP - EXCLUDED. <br />E44DORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2000 TS <br />A'TACNED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PQdOR LEAGUE SOFTBALL, INC. <br />?'.' T WALNUT AVE <br />?'tP.Pe,NK CA 91501 <br />SC <br />ISCI.CNI <br />PRINTED t 05-21-2007 <br />SC <br />