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I <br /> pox ~a~o~ . <br /> , A~ F~A~c~sa, ~A s~i o~o~ <br /> ~M~ENSATf~?N <br /> INURANC~ <br /> ~ ~ ~~~r~~N~~r~ of ~o~~t~~,. o~~~~u?~~r~~r~ ~ <br /> ~u~~~v~~ <br /> Ju~l~ ~i, ~4~4 P ~ ,1~~8643 <br /> ~ ICY NuI~B~~..:,.;..:..:: <br /> CERTIFICATE EMPIRE: ~ 1 ~ <br /> THE c r T~ a~ SANTA ANA <br /> THE BEi~4T OF SAfi~TA ANA <br /> 1040 EA"T SANTA ANA BL~~ <br /> SANTA ANA CA ~~741 <br /> C* <br /> This is to cer#ify that we have isseed a valid ylCaricers' compensation insurance policy in ~ farm approved by the ~alifarnia <br /> tns~rance Hamm€ssioner to the employer named below fvr the pal€cy period ir~dicated~ <br /> ~4 <br /> y~.4 <br /> This policy is not sub e # to car~cella#ior~ by tine ~ur~d except upon days' advance wrilter~ notice to the em la er. 1 <br /> p Y <br /> vie w€li also give yore ~~N days' advance notice shat~ld this olio bs cancel€ed rior t~ its ~ r <br /> p ~ p o mal explra#~on, <br /> <br /> This certificate of ir~s€~rance is na# are insurance policy aid does not amend, extend or alter the cavern a afforded b the ofic ~ <br /> listed herein, Natwithstandlr~g any requirement, term, or Condit€an o~ an contactor ~ Y P Y <br /> y other document with respect to which this <br /> <br /> certificate of insurar~ee may be issued or to which it may perta€n, the ir~s~rrance afforded by the pal€cy dascr€bed herein is subject <br /> <br /> #o afl the terms, exclusions and conditions of such poi€cy, <br /> A H~R~~ED REP~E~ENTATIVE PRESIDENT <br /> Ei~P~.~YER' S ~.I ABI~, ATV I T ~N~LUD ~ N(3 DEFEh~SE CDSTS s 1, 400 ~ 444 PER pCE~lRREN~E. <br /> F1~D~R5~hlENT f~~4b5 ENTITLED ~FRT~FCATE HO~.DERS'N~T1CE EFF~ECT~V~ <br /> 45~~~~14 1S ATTA~IFD TD AND FDRi~€S A PAPT 5l= T~1~5 PpLIEY. <br /> ll.4F <br /> r~' <br /> i.,It~~.#. ~.1~~~ ~r~~: <br /> ~S~~~Ic~~~k 4..,€~ ~~~i~r~e~ <br /> EMPt.DYER <br /> ~ VFNT~JHE CAPITAL FRQNT~FRS ANC <br /> DDA~ THE PAYPHgNE CU~PANYITHE ~AI~AN GHgHP <br /> u~~~T ~~~aN ASE <br /> ~n~ A~~~~.E~ EA ~4D~~ <br /> { <br /> <br />