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v <br />CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03 -01 -2012 <br />CITY OF SANTA ANA SP <br />BENEFITS DEPARTMENT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4058 <br />GROUP: <br />POLICY NUMBER: 1555105 -2012 <br />CERTIFICATE ID: 17 <br />CERTIFICATE EXPIRES: 03 -01 -2013 <br />03 -01- 2012/03 -01 -2013 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form app-ovod by t`a <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 />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - MARCUS D DAYHOFF, PRESIDENT CEO - EXCLUDED. <br />ENDORSEMENT #1600 - LETICIA A DAYHOFF, SECRETARY TREASURER - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03 -01 -2000 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />REACH EMPLOYEE ASSISTANCE INC SP <br />101 E LINCOLN AVE STE 230 <br />ANAHEIM CA 92805 <br />M0408 <br />(REV.8 -2010) PRINTED : 02 -17 -2012 <br />SP <br />