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'~ <br />POLICYHOLDER COPY <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: 04-20-2009 GROUP: 000562 <br />POLICY NUMBER: 0001424-2008 <br />CERTIFICATE ID: 40 <br />CERTIFICATE EXPIRES: 02-01-2010 <br />02-01-2009/02-01-2010 <br />CITY OF SANTA ANA <br />{~ <br />SP ~ <br />PO BOX 1964 - -i <br />SANTA ANA CA 92702-1964 <br /> i <br />~y~~ <br />~Y <br /> ` <br />' <br />V <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by <br />the <br />, <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 thb~ <br />loyer <br />~ <br />~ `. <br />~ <br />T- ~ <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 /> <br />~ ~-~- <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - MAHMOOD REZAI,PRES,CEO - EXCLUDED. <br />ENDORSEMENT #1600 - RUSTEEN REZAI, CEO - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />APPRO V viz ~~ I ~ ~ a <br />' 7 <br />I S itt ~ SI'i2C'-C1ti <br />Assistant City ~~-, j,~,.,, `, <br />EMPLOYER <br />INFOSEND INC. Sp <br />1041 S PLACENTIA AVE <br />FULLERTON CA 92831 <br />[JG8,CS] <br />SP <br />(REV.2-051 PRINTED 04-20-2009 <br />