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<br />CERTHOLDER COpy <br /> <br />SP <br />RECEIVED SEP 29 2006 <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: 10-01-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 1209902-2006 <br />CERTIFICATE ID: 31 <br />CERTIFICATE EXPIRES: 10-01-2007 <br />10-01-2008/10-01-2007 <br /> <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT AGENCY M-25 <br />POBOX 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 30 days advance written notice to the employer. <br /> <br />We will also give you 30 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 />a:::-REPRESENTATI <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />$1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-1992 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />-'. ;' ':'. ' <br /> <br />D~ )lS T(} I~Olll\,j <br /> <br />-. ...:. - ./ <br /> <br />EMPLOYER <br /> <br />----~ <br /> <br />:..\u";[u \...J:t t ':H,., _ . <br />A',-.o;lU'C;;~ ~.t~~~~,;, <br /> <br />MERCY HOUSE TRANSITIONAL <br />NON-PROFIT ORG. ) <br />PO BOX 1905 <br />SANTA ANA CA 92702 <br /> <br />LIVING CENTERS (A <br /> <br />M0408 <br /> <br />(REV.2-051 <br /> <br />PRINTED <br /> <br />09-17-2006 <br /> <br />t. t... <br />