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<br />FRDI" : = : .,.- I [IF S~IHH HtiH CDH <br /> <br />FH,', t~Ci, : 714 6-l7-=,~3f, <br /> <br />';eF. 11 200703:38H'1 F'...l <br /> <br />~_....- <br />_ I,",",i c; <br />COMP.NSATIOH <br />:~!i.W~A"C. <br />FUND <br /> <br />?O. BOX 42080;' SAN FRANClSCO.CA 94142-0807 <br /> <br />CERTIPICATl: OF WORKERS' COMPENSATION INSURANC~ <br /> <br />rnue 1lA~1' ~.14.1OO? <br /> <br />GFlOUP 00_' <br />POliCY NUMBER OOCO?72-2GDIl <br />CERTIFICATE 10. 1 <br />CER'!"lI'ICATE EXPIRES, 0.-14-_ <br />0.-1.-2001/04-14-1001 <br /> <br />CITY CP SANTA ANA <br />20 ~IVIC C!1frI~ P~AZA <br />SANTA _. CA 12102 <br /> <br />SP <br /> <br />Thie. 11; to e.rti''Y 'tMt wa hwe llAUed . VM~ \rVur.,Mt' Co~jor. =ft1Ul"1f'Ce poiie\' in 3 lOtm IPPfO~ bv t~ <br />CIllfor"" fnaur,nc. Ccmmln~Dl'Il!Ir to U'l. emploYIU MmeCl below for 1M patte,. "riod indtcttact, <br /> <br />Thtl IJD'IC:V IJ nDt IWJ.ct to c:.ncellf\ion by the 1OI.Jnd "!lCce.,t upot'l to day. ctvanc. wriU'" "uric. to U'le IlmplOY,T, <br /> <br />We will Il.e live VOU 10 dlVl MvlnCI no11ce '''''Idd ntlt poUev 1M' C'1n1:.Ued prlOt '0 )1:. I\OfrnM P'P',..tlO". <br /> <br />T'hlJ. ~iUL. at mliUfanCI is. nc" ., lnIurmc;e "utitrt' " doM; ng1; ."...,..a, .-xwnd or alter tho C1W1r1Q. affordedi <br />by Ih. J)oliev liat,lf her.ln.. NDtwith.~1"9 "')1' t".I~"'.manl, t.m Dr COI'\dl.tiftft ef aI'qI ecmIr.ll:t Dr .,th..r doeUl'fl.nt <br />~ r"~t to whtc.f'l thrs certi'lc.tI of ''''UT'ancer I'M.,. be' ..wed or to which It mIIV per",", 1M ~anCO' <br />.11ord.. 1>1 tno policy d...'.... _ IS _jet" to 411 .... !Irma. .~~""_. ON! e<>ndltloM. 01 _1>OI;cy. <br /> <br />\l:I:R~~ <br /> <br />~ <br /> <br />_IoOY!R'S LIMIUTY LIIUT INCWIl1Ill1 0ll~D1S" CIlST5: <br /> <br />~"'So;M" <br />.' . _. _ PPI 0Q;UIlII.-. <br /> <br />- <br /> <br />- <br /> <br />.~-." ",', <br /> <br />._ ;. I~:~~ or',") <br /> <br />~' (.~ :,:". ;'..~ <br /> <br />cft3 <br /> <br />EMP,OYER <br /> <br />,. ~._'- '. ......; j '~I"".-. w ~ <br /> <br />CIW/QI c;cuNTY /:IiIl._'S nmlAPEUT1: AIt'IS <br />UlI " 8~DaDWAY <br />SANTA ANA CA 12701 <br /> <br />SP <br /> <br />p'ltNflD 02-18-___ <br /> <br />''''E"V.ll-ODl <br /> <br />- <br /> <br />;.:-' <br /> <br />J <br />