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A - 20�i - I <br />CFI ;'t -OtAER COPY <br />PC Sex 8192. PLEASANTOTd. CA 94588 <br />7*;CATE Of WORIUM' COkPENSAT{ON WSURAME <br />ISSUE SATF 03 -03 -2014 <br />CITY OF SANTA ANA Sr <br />i"NEFITS DEPARTME? r <br />20 CIVIC CENTER PC2 <br />SIN-A ANA CA 42701 -40" <br />GRO'? <br />POUCY NLWAW gM106-201a <br />CeF'T!FICATE ID 22 <br />i^ZPT'PCATE EXPWiM, 03 -Ot 2016 <br />03 -01- 2016403 -£`t -7045 <br />TS 6 to Cerii!y dlat Wa IM-e 's -ued a Valid Wo'karf Cpr0wvsa4on !=ranee Fol'z:y {r a fam, =x oxtl q ehe <br />CaFfo.nu hr -T+oe ':aRS^ssinrF m he �:cyar MaMd 4wbwr '- xtne DcAoV acviod azhcoi <br />TM Paley x not subRedt to enee!lvien by 'he Fa,d except tyen 30 drys adv o +-Etten -n^les to " enetoyar. <br />We W, AR, #.* You 20 dm bekp eo nr!'ev chodd this oofiev be a , !lod Peet to 4s nermfl argiratlon <br />This ee'Wiese of htx.raree is not a' .term" potiey and daa n7 0-A14 exmnd or xlw d- -sW,se atlxw <br />M iM fey aced nerves Nffrwtlmu"'. ew . wm or of arq ac x 7aq/ 400ument <br />with, rea7ec+ to rr�+e!` +lS wnfCvy 01 i� ba Wued x t7 P nlaF ax vwkr4nae <br />a•`'_-raed by S ^r co;ic, tbst T' °9'eN� 9 n ekf to aA the -rn exattticm. and zi y &l mlicy. <br />AtF.l+e ^a!d e?r' es r'i 6-e P- -si +an rd MC, <br />FTaPI-DYER'S LTARTI,7T, LIMIT !NCLULITM DEFENSE COSTS $1,000.000 PER Or"RTNCE. <br />FN0p"mawr smo - NAR/1J5 D imvmFF PmroTNT CED - EXCLUDED. <br />FMOMRSEMENr ! *SOO - TF- - TA A DAV*AOfF SECRETARY TRTASt1RER - EXCLUDED. <br />WMEMENT f2066 ENTTTLID CE+RTTFICATE FOLMS' NOTICE EFFTCTr" 03 -01 -2000 IS <br />rTTACNFJ T ^. n.4e1 roaRas A aTr„T np TUIS PFR. CY. <br />- �MLO''A <br />REACR FwPtarrr .SiISTA13:E :Ar; SF <br />101 E I :rtts±, •.. +•rf - _ -- <br />wfvn -mta <br />tMKS r5' <br />-pr's^ 03 -04 2014 <br />SP <br />