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CERTHQLDER COPY <br />STATE p.0. BOX 420807, SAN FRANCISCO CA 94142-0807 <br />COMPENSATION , <br />INSURANCE <br />~~N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE; 05-30-2009 <br />GROUP: <br />POLICY NUMBER: 0355209-2009 <br />CERTIFICATE 1D: i 17 <br />CERTIFICATE EXPIRES: 05-30-2010 <br />05-30-2009/05»30-2010 <br />CITY OF SANTA ANA SP <br />ATTN CARLA THOMPKINS <br />PO HOX f988 M-25 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a vaild 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 yeu 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 6e issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to ail the terms, exclusions, and conditions, of such policy. <br />~~~ ~t7 " "`. e~ <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 1f2066 ENTITLED CERTIFIGATE HOLDERS' NOTICE EFFECTIVE 45-30-1990 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />-.~.. <br />EMPLOYER <br />ORANGE COUNTY FAIR HOUSING COUNCIL (A gp <br />NON-PROFIT CORP.) <br />201 5 BROADWAY <br />SANTA ANA CA 92701 <br />SP <br />fRev.z•os) PRINTED 04-17-2009 M040t3 <br />