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<br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />N _ 2-0D-7 ~ D7 C - 0 \ <br /> <br />IN REPLY REFER TO' <br /> <br />FEBRUARY 6, 2009 <br /> <br />CLERK OF THE CITY COUNCIL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M-30 <br />SANTA ANA CA 92701-4058 <br /> <br />CERTIFICATE OF WORKERS' <br /> <br />----------------------- <br /> <br />COMPENSATION INSURANCE <br /> <br />---------------------- <br /> <br />CANCELLATION NOTICE <br /> <br />------------------- <br /> <br />RE: CERTIFICATE DATED OCTOBER 14, 2008 <br /> <br />THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER <br /> <br />NAMED BELOW HAS BEEN CANCELLED EFFECTIVE JANUARY 27, 2009 AT <br /> <br />12:01 A.M. <br /> <br />IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE <br /> <br />CONTACT THE EMPLOYER NAMED BELOW <br /> <br />EMPLOYER: <br /> <br />ARC MID-CITIES <br />14208 TOWNE AVE <br />LOS ANGELES, CA 90061 <br />POLICY 567-0001087-08 <br /> <br />CUSTOMER SERVICES UNIT <br />LOS ANGELES DISTRICT OFFICE <br />(323) 266-5000 <br /> <br />1275 Market Street. San Francisco. CA 94103-1410 <br />Mailing Address: PO. Box 420807 . San Francisco, CA 94142-0807 <br /> <br />selF 19102 <br />