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ISSUE DATE: 03-01-2012 <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP: 000496 <br />POLICY NUMBER: 0500488-2011 <br />CERTIFICATE 1D: 288 <br />CERTIFICATE EXPIRES: 01-01-2013 <br />01-01-2012/01-01-2013, <br />SG JOB.-SANTA ANA REGIONAL TRANSPORTATION CTR <br />10000.E.SANTA ANA BLVD. <br />SANTA ANA <br />CA <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 />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - LYONS, RONALD PRESIDENT SECRETARY - EXCLUDED. <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-06-2012 IS <br />.�.... ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />RUE VAC PROPERTY SERVICES INC <br />600 Y TAFT AVENUE <br />ORANGE CA 928SS <br />SG <br />AS TO FWCM <br />_.. , l ±nrney <br />[B 17,SGI <br />(REV,8-2010) PRINTED : 03-01-2012 <br />