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<br />POLICYHOLDER COPY <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P,O, BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICA TE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 11-08-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 0776319-2006 <br />CERTIFICATE ID: 113 <br />CERTIFICATE EXPIRES: 09-01-2007 <br />09-01-2006/09-01-2007 <br /> <br />CITY OF SANTA ANA <br />SLDG INSPECTION DEPT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br /> <br />SP <br /> <br />JOS:ALL CALIFORNIA OPERATIONS <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 upon30 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 pelicy described herein is subject to all the terms, exclusions, and conditions. of such policy, <br /> <br />tREPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-1990 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />LEGAL AID SOCIETY OF ORANGE COUNTY (A SP <br />NON-PROFIT CORP,) <br />2101 N TUSTIN AVE <br />SANTA ANA CA 92705 <br /> <br />IREV,2-051 <br /> <br />PRINTED <br /> <br />[SLC,SPJ <br />11-08-2006 <br /> <br />