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<br />CERTHOLDER COPY <br /> <br />t,J .. <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.D. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 04-01-2007 <br /> <br />GROUP: 000488 <br />POLICY NUMBER: 0000562-2007 <br />CERTIFICATE ID: 5 <br />CERTIFICATE EXPIRES: 04-01-2008 <br />04-01-2007/04-01-2008 <br /> <br />CITY OF SANTA AHA <br />CONN. DEVELOPMENT AGENCY M-25 <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />SP <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in iI form approved by the <br />California Insurance Commissioner to the employer named below for the pOlicy period indicilted. <br /> <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br /> <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiriltion. <br /> <br />This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverilge afforded <br />by the pOlicy listed herein. Notwithstanding any requirement. term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it milY pertain. the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions. and conditions. of such policy. <br /> <br />CJ:::-REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />$1,000,000 PER OCCURRENCE. <br /> <br />A.=.;'~?~_-> l:..:..__) /~~~ 'T'/; ';;'-:~J.:_..Lv'1 <br /> <br />--c-~_ __~ <br /> <br /> <br />~,-,--,' .... ~,..'-"j <br /> <br />P....S........S[,';.L 2ity A.u~:<' .A~' <br /> <br />EMPLOYER <br /> <br />HUMAN OPTIONS DBA:HUMAH OPTIONS <br />PO BOX 53745 <br />IRVINE CA 92619 <br /> <br />SP <br /> <br />(REV.2-0S) <br /> <br />PRINTED 03-16-2007 <br /> <br />M0408 <br /> <br />