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CERTHOLDER COPY SP <br />P.O. BOX 420807, SAN FRANCISCO,CA 941420807 <br />FUND <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-14-2012 <br />THE CITY OF SANTA ANA SP <br />1000 E SANTA ANA BLVD, STE 200 <br />SANTA ANA CA 92701-3900 <br />GROUP: 000667 <br />POLICY NUMBER: 0000772-2911 <br />CERTIFICATE ID: 23 <br />CERTIFICA04 14 EXPIRES -012/04-14-2013 <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 />�tAu7th,Ci,dRepresentative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-14-2006 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />AMY? <br />,0 TO voo <br />LISA tY Ata neY <br />ASS�sta'� <br />f/ r' <br />EMPLOYER <br />ORANGE COUNTY CHILDREN'S THERAPEUTC ARTS SP <br />22113 N BROADWAY <br />SANTA ANA CA 92706 <br />PRINTED : 03-17-2012 <br />INEV.8-2010i <br />M0408 <br />