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ISSUE DATE: 04-14-2010 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M25 <br />SANTA ANA CA 92701-4058 <br />CERTHOLDER f'^Y <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807, <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />SP <br />GROUP: 000567 <br />POLICY NUMBER: 0000772-2009 <br />CERTIFICATE ID: 18 <br />CERTIFICATE EXPIRES: 04-14-2011 <br />04-14-2010/04-14-2011 <br />MAR25110 Pr -1 2:25 RUT <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 />ouc-� V&40 <br />tth,r,zed Representative Interim President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-14-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />A,p.PAO11r A8 TO <br />FARM <br />LISA F g-rORCK <br />Assistant City Attorney <br />EMPLOYER <br />ORANGE COUNTY CHILDREN'S THERAPEUTC ARTS <br />2215 N BROADWAY <br />SANTA ANA CA 92706 <br />SP <br />M0408 <br />(REV.1-2010) PRINTED : 03-17-2010 <br />SP <br />