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~~~~ <br />I V ~ COMPENSATION <br />I N S U R A N C E <br />~_ ~UNt~ <br />POLICYWOLDER COPY Sp <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORI(ERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10-01-2008 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M-25 <br />SANTA ANA CA 92701-4058 <br />SP <br />GROUP: 000238 <br />POLICY NUMBER: 0003338-2008 <br />CERTIFICATE ID: 11 <br />CERTIFICATE EXPIRES: 10-01-2009 <br />10-01-2008/10-01-2009 <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 />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - JEFFREY LOPEZ, PRE SEC TREA - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2007 IS <br />ATTACHED TO AND FORMS APART OF THIS POLICY. <br />APp~~ <br />_..-....-~--"~i 5t~eedy <br />~~Uta 5t~ ,yi~.ni•r~~,,. <br />t Cit~% <br />A5ti``t~n <br />EMPLOYER <br />DEKRA-CITE INDUSTRIES, INCORPORATED SP <br />3102 W ACTON AVE <br />SANTA ANA CA 92704 <br />(REV.2-05) PRINTED 09-17-2008 <br />M0410 <br />