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CERTHOLOER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07 -01 -2009 GROUP: <br />POLICY NUMBER: 0645891 -2009 <br />CERTIFICATE ID: 38 <br />C CERTIFICATE EXPIRES: 07 -01 -2010 <br />009 - 07- 01- 2009/07 -01 -2010 <br />SANTA ANA POLICE DEPARTMENT SK <br />FISCAL DEPARTMENT DIVISION M -97 <br />60 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4060 <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 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 />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 t6�:h policy. <br />�J <br />tTHOR�IZED REPRESENTATI PRESIDENT iV <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -01 -1989 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. - ;• O <br />EMPLOYER <br />ADLERICIRST INTERNATIONAL, <br />POLICE K -9 KENNEL <br />3551 'VERNON AVE <br />RIVERSIDE CA 92509 <br />IREV.2 -05) <br />INC. DBA: ADLERHORST <br />1� pg1Vl <br />Ap <br />2w €ttv Att �neY, <br />PRINTED : 06 -16 -2009 <br />c� <br />i <br />0 <br />N, <br />LO <br />rN <br />1%, <br />Lo <br />CD <br />SK <br />M0408 <br />