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F-'l_iM :F'ARFFIT II'I�,`i1TLITE FAx NCI_ a8- 4'J'4646 Fc-k,_ 0- 21,11[l P-17' 1 -DA11 PI <br />Fax Server 2 /2 /L010 4,:16:38 PM PAGE 3/003 Fix SeTV9x <br />POLICYHOLDER COPY <br />so <br />$TATS P.O. BOX 420607, SAN FRANCISCO.CA 94142 -0807 <br />C0MP1KN :ATIC?N <br />INS URANCI° <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />1SSIM DATE: 02 -02 -2010 GROUP: 000214 <br />POLICY NUMPER: 0000239 -2009 <br />CFaTIFIrArE ID: 94 <br />CERMFICATE ExPIRES:09 -01 -2010 <br />09-01- 2002/03 -01 -2010 <br />SANTA ANA POLICE ATHLETICAACT'TVITY LW_ACUF SD <br />2827 W MCFADDEN AVE <br />SANTA ANA CA 92704-2711 <br />This is tc rmriifv slot ww havc i.1t5ue.df a valid Workers' Companmion inxUrnncc pohCy ih a form "t-,proved by the <br />Califo-min In,uranre CornmlSSIOnAe In the empinynr named belaw for I;he policy "rrod indionted. <br />TN.; polloy to not aublect to ca ")cellation by the Fund et<nopl u00r 30 days ndvanao wntton tlntlr.a to the omolover. <br />wq will g190 give Vol.) 30 days RM(nnce notico should thig Policy l)9 canc.ellyd prtbr t0 iw rlr)r Rawl nxpirmliori, <br />7nin Cerliflcate a, ina„rnnc!; is hol an maUrance poilcy and down not amend, emi.ond or Alttr the coverngC Afforded <br />by the DOtIcV haled horoin, Notwltn^.tandln nlny rDatlimmRnL, term or tuandition of anV Cor,rr'ACl pr other ckiii .:vmnnl <br />�n /Il.h rorpecl to which this corllfical6 Of Tn9Urancn mab be ir,euryd or 'q WhiCh it mby pertain. `her )r. ?urAnCC <br />atfordnel tty the poiicv Clygcrlbed ncreln iG eubjoct to All the term«•. OxClmiona, nt-,d Conbltlona, pf nu& p01rr,V. <br />JT}.'C�RI7F.L? i'C�t'RFS = hlT!•tT I� PRF�IDENT <br />EMPLOYER'S LIABILTTY LIMIT TMCLIMING DEFENSE OOSTS7 51.000.000 PER DCCI,IRRENCE. <br />ENDORSEMENT 1120615 ENTITLED CERTIFICATE FOLDERS" WTICE EFFECTIVE 011-01-2001 IS <br />ATTAC3- m TO AND r -OFOAS A. PART OF THIS POLICY. <br />FMi'LUN'Eq <br />PARENT TNSTITUTE FOR QUALITY EDUCATION (A SO <br />NnN- PROFIT CORP,) <br />22 W 35TH ST STE 2!01 <br />NATIONAL CITY CA 01950 <br />(WH,CRIj <br />PRINTED ; 02 -02 -2010 <br />lncv.z�i�bf <br />