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<br />.' <br /> <br />CERTHOLDER COPY <br /> <br />SP <br />RECEIVED SEP 29 2006 <br /> <br />STATE <br />COMPENSATION <br />IN SURANCE <br />I=UNO <br /> <br />P.O. BOX 420807, SAN FRANCISCQ,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 />10-01-2006/10-01-2007 <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 /> <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 />-'. ""l'. ' <br /> <br />EMPLOYER <br /> <br />~ -:. ..''''; b.:J ft;4.S 'rUn. <br />~ 1";01(1\,1 <br />_._____ 'L;tJ:2.,x <br />i.~~-!;.. <br />---"c;~~ ~~~~,~;,;y <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 />(REV.2-051 <br /> <br />M0408 <br /> <br />PRINTED <br /> <br />09-17-2006 <br /> <br />e" R- " <br />