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<br />P0L1CYHOLDER COPY <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142.-0807 <br /> <br />CERTIFfCA TE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 11-02-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 1846993-2006 <br />CERTIFICATE ID: 2 <br />CERTIFICATE EXPIRES: 08-01-2007 <br />08-23-2006/08-01-2007 <br /> <br />CITY OF SANTA ANA <br />BLOG INSPECTION DEPT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <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 aiso 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 lllter 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 />&::-REPRESemATI <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 COIoMISSION (A NONPROFIT <br />PUBLIC BENEFIT CORPORATION) DBA: ORANGE COUNTY <br />YOUTH COMMISSION <br />1850 E 17TH ST STE 218 <br />SANTA ANA CA 92705 <br /> <br />IREV.2-05} <br /> <br />PRINTED <br /> <br />[KAF.CN] <br />11-02-2006 <br /> <br />