SOUTHWEST MINORITY EDA 10 - 2007

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.. CERTHOLDER COPY .' STATE COMPENSATION INSURANCE I=UND P.O. BOX 420807, SAN FRANCISCQ,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-29-2006 GROUP: POLICY NUMBER: 1800611-2006 CERTIFICATE 10: 1 CERTIFICATE EXPIRES: 10-29-2007 10-29-2006/10-29-2007 CITY OF SANTA ANNA CDBG ATTN: FRANK HERNANDEZ 20 CIVIC CENTER PLAZA P.O. BOX1988 SANTA ANNA CA 92702 SP This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement. term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain. the insurance afforded by the policy described herein is subject to all the terms. exclusions. and conditions. of such policy. a:::- REPRESENTATI EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: ~ PRESIDENT $1 ,000.000 PER OCCURRENCE. ::. ~ .- o. ~j. ~-'-;;-~' )1..S 'TO FO=~l'(_ --.-m ....:~c.. -:-:.-:-:----- ....;.;....,-;.:..jy EMPLOYER '-.:, ,y lu :.,,' ." SOUTHWEST MINORITY ECONOMIC DEVELPMNT AS DBA: SOUTHWEST MINORITY ECONOMIC DEVELO 1601 W 2ND ST SANTA ANA CA 92703 (REV.2-051 PRINTED 09-17-2006 SP N040S c';