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<br />CERTHOLDER COpy <br /> <br />'J Q <br />L., < SP <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: 03-01-2007 <br /> <br />GROUP: 000469 <br />POLICY NUMBER: 0003587-2006 <br />CERTIFICA TE rD: 3 <br />CERTIFICATE EXPIRES: 03-01 -2008 <br />03-01-2007/03-01-2008 <br /> <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT AGENCY <br />20 CIVIC CENTER PLAZA M25 <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 th~ employer. <br /> <br />We will a/so 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. Notwithstandin!il 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 />a:::- Ra'RESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />PRESIDENT <br /> <br />$1,000.000 PER OCCURRENCE. <br /> <br />EMPLOYER <br /> <br />BLIND CHILDRENS LEARNING CENTER <br />18542 VANDERLIP AVE STE B <br />SANTA ANA CA 92705 <br /> <br />SP <br /> <br />tp-..-.-..--... <br />.-...- .... ..- <br />~ ...w ,. -. <br /> <br />M0408 <br /> <br />(REV.2-05) <br /> <br />PRINTED 02-17-2007 <br />