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<br />CERTHOLDER COpy <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 06-01-2007 <br /> <br />GROUP: <br />POLICY NUMBER: 1801309-2007 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 06-01-2008 <br />06-01-2007/06-01-2008 <br /> <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT AGENCY M-25 <br />PO BOX 1988 <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 a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <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 expiration. <br /> <br />This 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 document <br />with respect to which this certificate of insurance may be issued 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 policy. <br /> <br />~REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br />~ <br /> <br /> <br />PRESIDENT <br />$1,000,000 PER OCCURRENCE. <br /> <br />EMPLOYER <br /> <br />J ...-,' <br /> <br />, --. r-'"',.-, <br />1'':1..0 .:..~..; <br /> <br />!C::"'~ ':f <br />..... ~-_. ..-.... <br /> <br />ASSISTANCE LEAGUE OF SANTA ANA <br />1037 W 1ST ST <br />SANTA ANA CA 92703 <br /> <br />~. . _,'n '.'..._.___'_ <br />.. .-..".... <br />- . > .. - -".j <br /> <br />SP <br /> <br />'.d ..~ ;.~~ ~:\.Y r;..';"..C:.::..:..~r <br /> <br />(REV.2-0S) <br /> <br />PRINTED 05-17-2007 <br /> <br />SP <br /> <br />M0408 <br />