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CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-19-2012 <br />CITY OF SANTA ANA SP <br />COMMUNITY DEVELOPMENT AGENCY <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br />GROUP: <br />POLICY NUMBER: 1962106-2012 <br />CERTIFICATE ID: 8 <br />CERTIFICATE EXPIRES: 01-01-2013 <br />01-01-2012/01-01-2013 <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 10 days advance written notice to the employer. <br />We will also give you 10 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 />,?? F4? <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />ILLUMINATION FOUNDATION SP <br />2691 RICHTER AVE STE 107 <br />IRVINE CA 92606 <br />[B17,SCj <br />SP <br />tRev.a zotol PRINTED : 04-19-2012