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POLICYHOLDER COPY SP <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />COMPENSATION <br />INSUMANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08 -23 -2007 GROUP: 000481 <br />�l r� j�/ b POLICY NUMBER: 0000413 -2008 <br />Al, CERTIFICATE ID: 1 <br />cR QV / -0 V CERTIFICATE EXPIRES: 08423 -2008 <br />08-23- 2007/08 -23 -2008 <br />CITY OF SANTA ANA Sp <br />DEPARTMENT OF PUBLIC WORKS <br />20 CIVIC CENTER PLAZA #M -21 <br />SANTA ANA CA 82702 <br />This is to certify that we have issued a valid Work or s'rgompensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for. the policynperiod indicated. <br />This policy is not subject to cancellation by the Fund ebtcept upon 30 days advance written notice to the employer. <br />We wily also give you 30 days advance-notica:-should ibis Policy- be.:cancalled 'prior to its -normal expiration Al <br />This certificate of insurance is not an .insurance policy aynd does not amend,-.extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requiremhnt, term or condition of any contract or other document <br />with respect to which this certificate of insurance maycbe 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 />tTHORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSS:COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08 -23 -2006 I5 <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EWLOYER <br />CURBSIDE, INC SP <br />1160 N ARMANDO ST <br />ANAHEIM CA 92808 <br />M0410 <br />IREV.2 -051 PRINTED 07 -17 -2007 <br />