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IN REPLY REFER TO: <br />SEPTEMBER 10, 2010 <br />CITY OF SANTA ANA <br />ATTN: ROBERT CARROLL <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />CERTIFICATE OF WORKERS' <br />----------------------- <br />COMPENSATION INSURANCE <br />---------------------- <br />CANCELLATION NOTICE <br />------------------- <br />RE: CERTIFICATE DATED JANUARY 15, 2010 <br />THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER <br />NAMED BELOW HAS BEEN CANCELLED EFFECTIVE AUGUST 1, 2010 AT <br />12:01 A.M. <br />IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE <br />CONTACT THE EMPLOYER NAMED BELOW <br />EMPLOYER: <br />CHRISTIANSEN AMUSEMENTS, INC <br />PO BOX 997 <br />ESCONDIDO, CA 92033 <br />POLICY 1553216-09 <br />CUSTOMER SERVICES UNIT <br />SACRAMENTO DISTRICT OFFICE <br />(916) 924-5072 <br />5860 Owens Drive • Pleasanton, CA 94588-3900 <br />Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 <br />$CIF 19102 <br />