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/9 98: 54P FROM: T0:5714235 P.2 <br />POLICYHOLDER COPY Sp <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CO"PENSATION <br />INSUMAjHCE <br />FUND �i D CERTIFICATE Of WORKERS' COMPMSATION INSURANCE <br />ISSUE DATE: 04-14-20M (53R0UP' <br />POLICY NUWBER: 1786151-20M <br />CERTIFICATE B: D4 14-2007 <br />CERTIFICATE £XPWES: <br />04-14-2008/04-14-20177 <br />CITY OF SANTA ANA SP <br />20 CMC CENTER PLAZA <br />SAWA AN4A CA 92702 <br />This is to certify Rat eve have issued a valid Workers' Compensation insurance policy in a form approved by the <br />Csrflmlb haun ce ccmmissiomr to the employer named below for the Policy Period idcited. <br />This policy is not subject to cancellation by the Fund except upon 1O days advance written notice to the employer. <br />we will also give you 10 days adance notice should this policy be cancelled prior to its normal expirstion <br />This certificate of insurance is not w insurance policy and does not amend. extend or alien the coverage afforded <br />by the policy irdad herein. Notwithstardina any reWlrement, term or condition of any contract Other dme ocunt <br />with respect to which this certificate of Insurance may be issued or to which it may Pertain <br />insurance <br />afforded by the policy described herein is subject to all the terns. exclusions, and conditions. of such Policy. <br />���y;71iiDRIZE>D 'fy�//� <br />ENpIM R'S LIABILITY LIMIT INCit1DING DEFENSE COSTS: St.000. ODD PM OCCUFM04..E <br />.� <br />ASS\skar <br />ORANOE COUNTY CHILDREN'S THERAPEUTC ARTS S� <br />208 K BROADWAY j <br />SANTA ANA CA 82701 <br />90400 <br />PRINTED : 02-1R-2006 <br />