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POLICYHOLDER COPY <br />SP <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: 04-14-2008 GROUP: 000567 <br />POLICY NUMBER: 0000772-2007 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 04-14-2009 <br />04-14-2008/04-14-2009 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLAZA <br />SANTA ANNA CA 92702 <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 such policy. <br />Cr� Jr•.e.�r `�=y�� <br />tTHORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-14-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />0% Z <br />SpRGo rey <br />Pss�a�'ar ' <br />EMPLOYER <br />ORANGE COUNTY CHILDREN'S THERAPEUTC ARTS SP <br />2215 N BROADWAY <br />SANTA ANA CA 92706 <br />M0409 <br />(REV.2-OS) <br />PRINTED : 03-18-2008 <br />