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~ ~' <br />POLICYHOLDER COPY SG <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-01-2009 GROUP: 000p9Z <br />POLICY NUMBER: 0000678-2008 <br />CERTIFICATE ID: 16 <br />CERTIFICATE EXPIRES: 01-01-2010 <br />01-01-2009/01-01-2010 <br />CITY OF SANTA ANA SG <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 80 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding 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 />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000.000 PER OCCURRENCE. <br />ENDORSEMENT 1/1600 -ROGER FRANK, PRES -EXCLUDED. <br />ENDORSEMENT X1800 -ALAN FRANK, S,T -EXCLUDED. <br />ENDORSEMENT X2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. ^.~ <br />© ~~ I <br />~~ <br />'Q~`~~~ - ORGK ey <br />LISP ~.G y P~~oC~ <br />PSS`S~art <br />EMPLOYER <br />JOFNSON-FRANC & ASSOCIATES (A CORP) AND/ SG <br />DBA:JOHNSON-FRANC 8 ASSOCIATES <br />5150 E HUNTER AVE <br />ANAHEIM CA 92807 <br />M0410 <br />(REV.2-o5) PRINTED 12-20-2008 <br />