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<br />CERTHOLDER COPY <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />PO BOX 420807, SAN FRANCISCO.CA 94142.-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE' 09-06-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 1846993-2006 <br />CERTIFICATE 10: 1 <br />CERTIFICATE EXPIRES, 08-01-2007 <br />08-23-2006/08-01-2007 <br /> <br />FRANCIS CADENAS - YOUTH COUNSEL <br />CODR-WIB\YOUTH CDUNCEL <br />888 W SANTA ANA BLVD RM 214 <br />SANTA ANA CA 92701-4S61 <br /> <br />SP <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />C.alifornia Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />Th;s policy is n01 subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br /> <br />VI/e wi:! ..'so give you 10 days advance notice shoiJld this policy be cancelled prior to its normal expiration. <br /> <br />"-his certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other documen: <br />with respect to which this certificate of insurance may be issued cr to which it may pertain, the insurance <br />afforded bv the policy described herein IS subject to all the terms. exclusions, and conditions, of such policy. <br /> <br />tt::-REPRESENTA~I <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />EMPLOYER <br /> <br />ORANGE COUNTY YOUTH COMMISSION (A NONPROFIT <br />PUBLIC 8ENEFIT CORPORATION) <br />1850 E 17TH ST STE 218 <br />SANTA ANA CA 92705 <br /> <br />PRINTED <br /> <br />[CAA.SC) <br />09-06-2006 <br /> <br />IREV.2-05l <br />