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POLICVHDLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 844588 <br />CERMFICATE OF WORKERS' COMPENSATMN 04SURANCE <br />ISSUE DATE: 07 -09 -2094 <br />SANTA ANA POLICE DEPARTMENT <br />FISCAL DEPARTMENT DIVISION M -67 <br />60 CIVIC CENTER PLZ <br />SANTA ANA CA 62709-4060 <br />HE <br />GROUP: <br />POLICY NUMBER: 6697352 -2014 <br />CERTIFICATE ID: 5 <br />CERTIFICATE EXPIRES: 07- 04 -209E <br />07- 09- 2094/07- 09 -209E <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_,0 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 />//4 4 d <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $9,000,000 PER OCCURRENCE. <br />ENDORSEMENT X2066 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -04 -2092 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />ADLERHORST INTERNATIONAL, <br />POLICE K -6 KENNEL <br />3654 VERNON AVE <br />RIVERSIDE CA 62506 <br />IRE V:1 -2012) <br />A. / T <br />ROVED AS TO Fq�ORM� p <br />Laura A. Rossini <br />istant City Attorney <br />INC. DBA: ADLERHORST <br />PRINTED : 06-97 -2094 <br />M0490 <br />si< <br />