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<br />~ .-.~... <br />.,..:._~ <br />'iIP' il"-". ... <br />COMPBNSATION <br />:~~=~~AHCB <br />FUND <br /> <br />P.O. BOX 420807. SAN FRANC1SCO.CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 04-14-2007 <br /> <br />GROUP: 0005117 <br />POliCY NUMBER: ??oo772-2008 <br />CERTIFICATE 10: t <br />CERTIFICATE EXPIRES: 04-'4-2008 <br />04-14-2007/04-14-2008 <br /> <br />CITY DF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA CA 12702 <br /> <br />SP <br /> <br />This is to certify that we hwe i"ued a valid WorKer,' Compensation Insurance policy in a form approved bV the <br />California Insurmce Commissioner to the employer named below for the policy period indlCllted. <br /> <br />ThiS poliCY IS not subject to clOcellation by the Fund except upoh 10 days advance written notice to tne emplover. <br /> <br />We will also gille 'IOU 10 days advance notice should this policy ~e cancelled prior to it, r\OI"mal expiration. <br /> <br />This csrtitlcite ot insurance is not in IllSurmc8 policy iIrld does not armand. extend or alter the C"CWClfago afforded <br />by the policy listed herein. Notwithstanding any requiremllnt termOt' condition of ~V contract or other document <br />with respect to wl\lch this certificate of insurance may be issued or to which it m.y pertain. thsinsurance <br />afforded by the policy described hllrllin is subject to all ~ tel1Tl$. exclusions. and' conditions. of $uetr policy. <br /> <br />&"..:~ <br /> <br />EMPLOVER'SL.IABILITY LIMIT INCWDING DEFENSE COSTS: <br /> <br />~ <br /> <br />PRESlDiNT <br />$1 .000,000 PER OCQIRRI:NC&. <br /> <br />..,~? -~ ",...' <br /> <br />,~) Ie:) TO <br /> <br />r::()::z \,"i <br /> <br />If? <br /> <br />. c. . . '- . 'I . '.. . . , _ ...~, <br /> <br />EMPLOYER <br /> <br />." :.-. ~::.: .; ~ <br /> <br />'- _ - ~ i <br />......,,'1 <br /> <br />/'J... r t :,.;.~' ~..:y <br /> <br />QRANGE COUNTY CHILDREN'S THERAPWTC ARTS <br />2211 N BROADWAY <br />SANTA ANA CA 12701 <br /> <br />SP <br /> <br />M0401 <br /> <br />PRINTED 03-t8-2oo7 <br /> <br />lREV.2-05l <br /> <br />J <br /> <br />