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POLICYHOLDER COPY <br />5D <br />P.O. BOX 420807, SAN FRAIVCISCO,CA 94 1 42 -0 80 7 <br />CERTIF]C/4TE OF WORKERS` COMPENSATION INSURANCE <br />ISSUE DATE: 01 -01 -2072 � GROUP: <br />POLICY NUMBER: 187.5457- -2012 <br />CERTIFICATE 16 11 <br />CERTIFICATE EXPIRES: 01 -01 -2013 <br />D1 -O7- 2072/01 -01 -2013 <br />CITY OF SANTA AI4A - -SD <br />PURCHASING DEPT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4058 <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 pelicy period indicated. <br />This policy is not subject to dancellatlon 6y -the Fund except upcn 30 days advance written notice to the employer. <br />We wilt 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 Ilsted herein_ No #withstanding any requirement, term or condition of any contract or other document <br />wath respect to which this certlf irate of insurance may ba lssuad or to which K may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms�e x�cl�us{on�s+, (/(a//n}d conditions, of sucfi policy. <br />Authorlaed Representative � President and CEO <br />EMPLOYER'S LIABILITY LIMIT ZNC LUDING DEFENSE COSTS: $1,000,000 PER OCCIIRR ENCE. <br />ENDORSEMENT #2066 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01 -01 -2009 IS <br />ATTACHED�TO AND FORMS A PART pA THIS POLECY.- - <br />.1'd' it(� �/ I_ t> l,S 'T'O FOIZNI <br />..___— �� <br />Laura Slat[ .Snccdy� <br />�.- �,isL�nt City Film rnc:•. <br />EMPLOYER <br />HADRONEX., INC SD <br />38.1 ENQEL ST <br />ESCONDIDO CA 92029 <br />{Bt4,SD], <br />PRINTED 02 -01 -2012 <br />IREV.a- 10.101 <br />