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CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,cA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10-01-2007 GROUP: <br />POLICY NUMBER: 0720284-2007 <br />~v- acx~ _053 <br />CERTIFICATE ID: 3 <br />~y_ ~(jJG U? ~ ~ V / CERTIFICAIO-01 P2oti7/10-01-2008 <br />c:Tr of SAAfTA ANA N-2007-112 sP <br />ATTN~ CITY CLERK <br />Po Box 16ee <br />sAMTA ANA a 62702-16aa <br />Tn~s ~s to certify tfut we love issued a valid Workers' Compensation Insurance Dohcy m a form approvetl by the <br />Cal~forn~a Insurance Commissioner to the employer named below for the policy penod mdlCated <br />This policr ~s not sublet[ to cancellation by the Fund except upon 10 days advance written notice to the employer. <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certitlcate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the Dohey fisted herein. Notwithstanding any requirement, term or condlUOn of any contract or other document <br />with respect to wh¢h this certificate of insurance may be issued or to whicfi it may pertain, the Insumce <br />afforded by the policy descrihetl herein is subject to all the terms. exclusions, and contlitions, of such policy. <br />THORIZED REPRESENTATI <br />~~~ ~~ <br />PRE510ENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. <br />ENDORSEMENT x1700 - MARTHA ARGU ELLES - EXCLUDED. <br />ENDORSEMENT Mt700 - PATRTCIA FITZGERALD - EXCLUDED. <br />ENDORSEMEM e1700 - SALLY M. LOW - EXCLUDED. <br />n-'c "' <br />T m <br />.. _ -o <br /> fJ <br /> V <br /> y <br />. <br />g <br />C7' <br />t7 ~' <br />r x ,Ct <br />D <br />EMPLOYER <br />MARTHA ARGUELLES, AND SALLY M. LOW AND SP <br />PATRICIA FIT2GERALO DBA: BR02EY, LOW & <br />ARdIELLES <br />800 W SANTA ANA BLVD STE 208 <br />SANTA ANA CA 82701 <br />SP <br />M0408 <br />IREV.2-os PRINTED 09-17-2007 <br />