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<br />'" 08:54P FROM: <br /> <br />TO: 57H235 <br /> <br />POLICVHOLDER COPY <br /> <br />STATE <br />COMPRHSATION <br />INSUfIilAHCE <br />FUND <br /> <br />P,O. BOX 420807. SAN FRANCISCO,CA 94142-0607 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />iSSUE OATE: 04-14-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 1706151-2006 <br />CERTIFICATE 10: 4 <br />CERTIFICATE EXPIRES, 04-14-2007 <br />04-14-2006/04-14-2oo? <br /> <br />CITY DF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA AIlN/. CA S2702 <br /> <br />SP <br /> <br />This is to certlty th.\ \Nfl nlllJe issued a vilid Work.ers' Compensiltion inSUfinC8 policy in OJ form approved by the <br />Califomli Insursnoe Commissione, to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to canc8t1ation by tne Fund except upon 10 days .evmoB written notice to the employer. <br /> <br />We will also give you 10 day~ actvilnce notice should thl$ pOliCY bel cancelled prior to its normal expiration.. <br /> <br />This certificate of insurance is not an insurance policy and does not amend. extend or a1t8~ the coverage afforded <br />by me policy Iis.ted herein. Nctwithstandinc any requirement. term or condition of any contract or other document <br />with r.~t to whli;h thi~ certific:iirt6 of Tnsurllrace may b$ iuued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditions. of such polic:y. <br /> <br />tt::RE~ <br /> <br /> <br />EMPLOYER'S LIABILITY LIMiT INCLUOING DEFENSE COSTS: <br /> <br />~ <br /> <br />PRESIDENT <br />$1.000.000 PE~ OCCURRENCE, <br /> <br />- <br /> <br />~;; -" <br />/0 ; <br />r \).. <br />.~p /" <br />':"'?->-P~. /" ('y <br />..J'\j ~J... <br />'.;. ...J' .-,' <br />. __ :\oS((,", <br />./ "',S \,>0-0 <br />'v\S\' "- ci\'l , ) <br />''6'" , I <br /> <br />P'(j ~k~ <br /> <br /> <br />E!\!El.O-<Ef>---" - <br />~ <br /> <br />--.-\ <br /> <br /> <br />ORANGE COU~~Y CHILDREN'S THERAPEUTC ARTS SyI <br />208 N BROADWAY <br />S~~A ANA CA 82'01 <br /> <br /> <br />PRINTED <br /> <br />03-1S-200e <br /> <br />{REV.2-051 <br /> <br />P.2 <br /> <br />S. <br /> <br />M040S <br />