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Sep. 13. 2011 10:29AM No. 0868 P. 4 <br />POLICYHOLDER COPY <br />$K <br />P.O. l30X 420807, SAN FRANCISCO,CA 94142 -08Q7 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07 -01 -2017 GROUP: 000627 <br />POLICY NUMBER: 0000293 -2011 <br />CERTIFICATE ID: 6 <br />CERTIFICATE EXPIRES: 07 -07 -2072 <br />07 -Of- 2011/07 -Qi --2012 <br />SANTA ANA POLICE DEPARTMENT SK <br />FISCAL DEPARTMENT DIVISION M -97 <br />60 CIVIC CENTER PLZ _ <br />SANTA ANA CA 82707 -4060 <br />This is to certify that wa have issued a valid Workers' Compensation Insurance policy in a form approved by the <br />California Insurance Gomm1661oner 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 writt6 r, notice to the employer. <br />We will also give you 30 days advance notice should [Ells policy ba cancelled prior [o ICs normal expiration. <br />This certificate of Insurance is not an insurance policy and does not amend, extend or alter [he coverage afforded <br />by the policy listed herein. Notwithstan Ding any requirement, term or condiilon of any contract or ether document <br />will, respect to which this certificate of Insurance may be Issued or to which it may pertain, the insurance <br />aflorded by the policy described herein is subject to all the terms, exclusions, and condlllon6, of such policy. <br />Authorized Represen[a[IVe President and CEO <br />EMPLOYER•s LYA9ILITY LIMIT INCLUDING DEFENSE COSTS: 31,000,000 PER OCCURRENCE. <br />ENDORSEMENT g20B5 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -07 -2077 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />APPROVES AS �l' /O [f+ORM <br />� n �i�l- <br />-� <br />TERE.4A L. � <br />�� C� A <br />IgPiitl Ral'lA: <br />ADLERHORST INTERNATIONAL, INC- DBA: 4DLERHORST <br />POLICE K--9 KENNEL <br />3867 VERNON AVE <br />RIVERSIDE CA 92609 <br />[SMC,CN] <br />PRINTED 09 -09 -2077 <br />tREV.B -2olal <br />