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CERTHOLDER 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: 09-01-2007 GROUP: <br />POLICY NUMBER: 0776319-2007 <br />CERTIFICATE ID: 132 <br />CERTIFICATE EXPIRES: 09-01-2008 <br />09-01-2007/09-01-2008 <br />CITY OF SANTA ANA SP <br />COMMUNITY DEVELOPMENT AGENCY CDBG M-25 <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 80 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 REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-1990 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />LEGAL AID SOCIETY OF ORANGE COUNTY (A SP <br />NON-PROFIT CORP.) <br />2101 N TUSTIN AVE <br />SANTA ANA CA 92705 <br />M0408 <br />PRINTED : 08-17-2007 <br />IEV.2-05) <br />SP <br />