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K - 200$--C)JATHOLDER COPY <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: 04-14-2008 GROUP: 000567 <br />POLICY NUMBER: 0000772-2007 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 04-14-2009 <br />04-14-2008/04-14-2009 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA CA 92702 <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 `tjthee�terms, <br />exclusions, and conditions, of such policy. <br />V <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT <br />5 ENTITLED CERTIFICATE <br />HOPOLLDERS' NOTICE EFFECTIVE 04-14-2008 IS <br />ATTACHEDAND <br />EMPLOYER <br />ORANGE COUNTY CHILDREN'S THERAPEUTC ARTS SP <br />2215 N BROADWAY <br />SANTA ANA CA 92706 <br />jJRL,CN] <br />PRINTED : 07-07-2008 <br />(REV.2-05) <br />SP <br />