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-. CERTHOLDER COPY SP <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: 10-01-2007 GROUP: <br />POLICY NUMBER: 1375218-2007 <br />CERTIFICATE ID: 27 <br />CERTIFICATE EXPIRES: 10-01-2008 <br />10-01-2007/10-01-2008 <br />CITY OF SANTA ANA SP JOB:BRIDGES PROGRAM <br />20 CIVIC CENTER PLZ M-23 <br />SANTA ANA CA 92701-4058 <br />Th,s •s to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />Caiifo,ma Inswance Commissioner to the employer named below for the policy period indicated. <br />This poi,cy ,s not subject to cancellation by the Fund except upon 30 days advance written notice 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 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 />wit?, 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 />t!THOR�IZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2007 IS <br />ATTACKED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />ORANGE COUNTY HUMAN RELATIONS COUNCIL (A SP <br />NON-PROFIT CORPORATION) C/O COUNCIL <br />1300 S GRAND AVE STE B <br />SANTA ANA CA 92705 <br />M0408 <br />(REV.2-05) PRINTED : 09-17-2007 <br />