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CERTHOLDER COPY <br />STATE P.O.80X 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />~U N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE GATE: 10-01-2007 GROUP: <br />POLICY NUMBER: 1375218-2007 <br />CERTIFICATE 1D: 27 <br />CERTIFICATE EXPIRES 10-01-2008 <br />10-01-2007/10-01-2008 <br />CITY Of SANTA ANA <br />20 CIVIC CENTER PLZ M-2S <br />SANTA ANA CA 9701-40s~ <br />SP J08:BRIDGES PROGRAM <br />Tn~s •s to cert~ty that we have issued a valid Workers' Compensation insurance policy m a form approved by the <br />Ca+~~o•n~s !nsurance Comm~ss~oner to the employer named below for the policy period ~nd~cated. <br />This Do~~cy ~s not subject to cancellation by the Fund except upon 30 days advance written nonce to the employer. <br />We w i! also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This cert:t~cate of msurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the Doi~cv listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />wits 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 />~THOR!2E0 REPRESENTATI <br />-~~c~-- e-,-- <br />PRESfDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. <br />ENDORSEMENT M2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2007 IS <br />ATTAC-!ED TO AND FORMS APART OF THIS POLICY. <br />EMPLOYER <br />ORANGE COUNTY HUMAN RELATIONS COUNCIL (A <br />NON-PROFIT CORPORATION) C/0 COUNCIL <br />1300 S GRAND AVE STE B <br />SANTA ANA CA 92705 <br />SP <br />SP <br />M0408 <br />(REV.2-05) PRINTED 09-17-2007 <br />