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<br />CERTHOLDER ror"lPY <br /> <br />STATE <br />COMPENSATION <br />INSU~ANC. <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0B07 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 02-01-2007 <br /> <br />GROUP, 000488 <br />POLICY NUMBER: 0000628-2008 <br />CERTIFICATE 10: 5 <br />CERTIFICATE EXPIRES: 02-01-2008 <br />02-01-2007/02-01-2008 <br /> <br />CITY OF SANTA ANA COBG M-25 <br />CDNl<<JNlTY DEVELOPMENT AGENCY <br />P.O. BOX 1888 M-28 <br />SANTA ANA, CA 82702 <br /> <br />SP <br /> <br />~08:RE: FUNDING <br /> <br />This is to certify tnat we have issued a valid Workers' Compen~on insunilnce policy in .. form approved by the <br />California Insurance Commissioner to the employer ~ed below for the policy period Indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 dly$ advanc. written notice to the employer. <br /> <br />We will also give you 30 days .dvance notice should this pOlicy be cIMcefled prior to its normal expiration. <br /> <br />This certificate of insur.ance is not an insurance policy .,d does not amend. extend or alter the coverage afforded <br />by the policy listed herein. Notwithst.llndin~ 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 policy described herein is subject to all the terms, exclusions. .and conditions. of such policy. <br /> <br />tt::- REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />$1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br /> <br />TEEN CHALLENGE OF SO CA , INC <br />5445 CHICAGO AVE <br />RIVERSIDE CA 92507 <br /> <br />SP <br /> <br />CAEV.2-05] <br /> <br />PRINTED <br /> <br />01-19-2007 <br /> <br />SP <br /> <br />M04D8 <br />