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<br />~, <br /> <br />01/18/2007 12:39 <br /> <br />7148350282 <br /> <br />FAIR HOUSING COUNCI' <br /> <br />PAGE 02/02 <br /> <br />POLICYHOLDER copy <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSUftA"CIi <br />FUND <br /> <br />. ~,:!'r <br /> <br />~1,l1.!:;~ <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORK&RS' COMP,ENSATION INSURANCE <br /> <br />ISSUE DATE: 05-30-200'7 <br /> <br />GROUP: <br />POLICY NUMBER: 0315520~- 2007 <br />CERTIFICATE 10: 117 <br />CERTIFICATE EXPIRES: 01l-3O- 2CIOB <br />05-30-2007/05-30- 2(IOB <br /> <br />C;ITY OF SAm A ~ <br />ATTN CARLA Tl<<JMf'KINS <br />PO BOX 1988 M-2S <br />SANTA ANA CA 92702 <br /> <br />SP <br /> <br />This is to certify th3t we halle issued II valid Workers' Compenslllion insurance policy in a form app -0\ eo by the <br />California Insurance Commissioner to the employer named below for the policy period indicated- <br /> <br />ThiS poliey is nol subject to cancellation by t1\8 Fund except upon 30 diYS advance written notice t:> .:t)e employer. <br /> <br />We will also give YOU 30 days adv..nce notiCIl! should this policy be cancelled prior to its normal C1xoir,ition. <br /> <br />This certificate of insurill"lce is not an insur8flce policy .."d does not amend. extend Qr alter the cO\ierllge "fforded <br />by the policy li~led herein. Notwith5landing :!KIY requirement term or condition of any contr~t or ott]gr document <br />with resPect to which this certificate of insurance mane issued or to which It may pertain. the Insl,lr,mce <br />afforded bY the !Jolicy described herein is sutJject to ..II the term.. exclusions. and conditio"s. of sud, policy. <br /> <br />cr::~~ <br /> <br /> <br />EMPLOYE~'S ~IABILITV LIMIT INCLUDING DEfENSE COSTS: <br /> <br />~ <br /> <br />F>RE:SIOENT <br />$1,000,000 pr~ OCCURRENCE. <br /> <br />ENDO~SEMENT #2085 ENTITLED CERTIfICATE HOLDERS' NOTICE EFFECTIVE 05-30-1990 IS <br />ATTAa-lED TO AND P'DItM5 A PART Of THIS POLICY. <br /> <br />f'. d;{1~' ,".' <br />;;;",~,,',~;I <br /> <br />- <br /> <br />EMPLOYER <br /> <br />ORANGE COUNTY J<AIR ttOUSINe COUNCIL (A <br />NON-PROFIT CORP.) <br />201 S BROADWAY <br />SANTA ANA CA 112701 <br /> <br />SP <br /> <br />~: ,~.t~I" :~;'jl <br /> <br />(REV.:l-O$) <br /> <br />M0410 <br /> <br />PRINTED <br /> <br />04-1'7-2007 <br />