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STATE <br />COMPENSA710N <br />I N S U R A N C E <br />FUND <br />FEBRUARY 6, 2009 <br />N ,~~,~-7 r ~,~~ c - ~ t <br />CLERK OF THE CITY COUNCIL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M-30 <br />SANTA ANA CA 92701-4058 <br />CERTIFICATE OF WORKERS' <br />COMPENSATION INSURANCE <br />CANCELLATION NOTICE <br />RE: CERTIFICATE DATED OCTOBER 14, 200$ <br />IN REPLY REFER TO: <br />THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER <br />NAMED BELOW HAS BEEN CANCELLED EFFECTIVE JANUARY 27, 2009 AT <br />12:01 A.M. <br />IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE <br />CONTACT THE EMFLOYER NAMED BELOW <br />EMPLOYER: <br />ARC MID-CITIES <br />14208 TOWNS AVE <br />LOS ANGELES, CA 90061 <br />POLICY 567-0001087-08 <br />CUSTOMER SERVICES UNIT <br />L05 ANGELES DISTRICT OFFICE <br />(323) 266-5000 <br />1 275 Market Street • San Francisco, CA 941 03- 1 410 <br />Marling Address: P 0. Box 420807 • San Francisco, GA 94 1 42-080 7 <br />SCIF 19702 <br />