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<br />SP <br /> <br />POLICYHOLDER copy <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />p,O, BOX 420807, SAN FRANCISCQ,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />GROUP: 000238 <br />POLICY NUMBER: 0003338-2007 <br />CERTIFICATE 10: 11 <br />CERTIFICATE EXPIRES: 10-01-2008 <br />10_01-2007/10-01-2008 <br /> <br />ISSUE DATE: 10-01-2007 <br /> <br />SP <br /> <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M-25 <br />SANTA ANA CA 92701-4058 <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will aiso give you 30 days advance notice should this policy be cancelled prior to its normal expiration, <br /> <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 /> <br />~ ~ ~~,. <br /> <br />\JTHORiZED REPRESE:'ATIG <br />EMPLOYER'S LIABILITY LIMIT INCLUOING DEFENSE COSTS: <br /> <br />PRESIDENT <br /> <br />$1.000,000 PER OCCURRENCE. <br /> <br />ENOORSEMENT #IBOO _ JEFFREY LDPEZ. PRESIDENT TREASURER - EXCLUDED. <br />ENDORSEMENT #1600 - NANCY LYNN LOPEZ, SECRETARY - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2007 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />i' ~ -~' l' <br /> <br />'. ~ <br /> <br />TO I'll."" <br /> <br />~ <br /> <br />-..--- <br /> <br />-- <br /> <br />p, ' <br /> <br />,~ :' <br /> <br />EMPLOYER <br /> <br />DEKRA-LITE INDUSTRIES, INCORPORATED <br />3102 W ALTON AVE <br />SANTA ANA CA 92704 <br /> <br />SP <br /> <br />M0410 <br /> <br />PRINTED <br /> <br />10-03-2007 <br />