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IN REPLY REFER TO: <br />JULY 13, 2012 <br />SANTA ANA POLICE DEPARTMENT <br />FISCAL DEPARTMENT DIVISION M -97 <br />60 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4060 <br />CERTIFICATE OF WORKERS' <br />----------------------- <br />COMPENSATION INSURANCE <br />---------------------- <br />CANCELLATION /CONVERSION NOTICE <br />------------------------ - - - - -- <br />RE: CERTIFICATE DATED JULY 1, 2012 <br />THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE <br />POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY <br />EFFECTIVE JULY 1, 2012. THE NEW POLICY WILL PROVIDE <br />UNINTERRUPTED COVERAGE. <br />YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER <br />THE NEW POLICY NUMBER: 9017352 -12. <br />IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CUSTOMER <br />SERVICES UNIT AT THE NUMBER LISTED BELOW. <br />EMPLOYER: <br />ADLERHORST INTERNATIONAL, INC. <br />3951 VERNON AVE <br />RIVERSIDE, CA 92509 <br />POLICY 527 - 0000283 -12 <br />CUSTOMER SERVICES UNIT <br />RIVERSIDE DISTRICT OFFICE <br />(909) 384 -4500 <br />5860 Owens Drive - Pleasanton, CA 94588 -3900 <br />Mailing Address: P.O. Box 8192 - Pleasanton, CA 94588 -9682 <br />SCIF 19102 <br />