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CERTHOLDER COPY <br />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: 05-13-2008 GROUP: 000562 <br />POLICY NUMBER: 0001188-2007 <br />CERTIFICATE ID: 28 <br />CERTIFICATE EXPIRES: 09-01-2008 <br />09-01-2007/09-01-2008 <br />CITY OF SANTA ANA SG JOB:CDBG 08-09 <br />COMMUNITY DEV AGENCY DEPT <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <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 30 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 />tHORIZED REPWRESENTATAU PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2006 IS <br />ATTACHED TO AND FORMS A PART OF TRIS POLICY. <br />EMPLOYER <br />PEOPLE FOR IRVINE COMMUNITY HEALTH (A SG <br />NON-PROFIT CORP.) DBA: 2-1-1 ORANGE COUNTY <br />2183 FAIRVIEW RD STE 107 <br />COSTA MESA CA 92627 <br />[RRC,CNj <br />(REV.2-05) PRINTED : 05-13-2008 <br />