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STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />I N S U R A N C E <br />V N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />,7ANUARY 14, X010 POLICY NUMBER:19~GE97 1~ <br />CERTIFICATE EXPIRES:1-1-11 <br />THE CITY OF SANTA ANA <br />ATT:DOUG MCGEACFIY,COMMRNDER TRAFFIC DIVISION <br />F'0 BOX 1981 <br />SANTA ANA CA 9~7~~ JOB: LICENSE GRANTING RIGHT OF <br />ENTRY LIGHTS ON PROGRAM <br />FLOWER STREET <br />~- CITY OF SANTA ANA <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California <br />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 ten days' advance written notice to the employer. <br />We will also give you TEN 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 by the policy <br />listed herein, Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this <br />certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject <br />to all the terms, exclusions and conditions of such policy. <br />A HORIZED REPRESENTATIVE <br />~`~°--~- <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: S1,~D00,O~i~ F'ER OCCURRENCE. <br />EMPLOYER <br /> <br />COUNCIL OF ORANGE COUNTY <br />50CIETY OF ST. VINCENT DE PAUL <br />8V~14 MARINE WAY <br />IRVINE CA 9:618 <br /> <br />APPROVP~ ~S ~~ lF®I <br />~ ~ <br />~. X596 <br />SCIF10262(REV 02-OS) <br />