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CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142 -0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUN ® CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 06 -10 -2005 GROUP: <br />POLICY NUMBER: 1593254 -2004 <br />CERTIFICATE ID: 115 <br />CERTIFICATE EXPIRES: 08 -01 -2005 <br />08- 01- 2004/08 -01 -2005 <br />CITY OF SANTA ANA <br />PERSONNEL SERVICES DEPT.,.- <br />PO BOX 1988 <br />SANTA ANA CA 927 -02 <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />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 advances. 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 by the <br />policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of Insurance may be Issued or to which It may pertain, the Insurance afforded by the policy <br />described herein is subject to all the terms, exclusions and conditions, of such policy. <br />�6� A,, e . <br />AUTHORIZED REPRESENTATIVE <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08 -01 -2002 IS <br />ATTACHED.. TO AND FORMS .A PART OF .THIS POLICY. <br />EMPLOYER _ <br />LIFESIGNS NOW AND /OR (A NON - PROFIT <br />PUBLIC BENEFIT CORP.) <br />2222 LAVERNA AVE <br />LOS ANGELES CA 90041 _. ..[1316,81-] <br />SCIF 10262E Accernthis cerificale only ifyou see a faint watermark that reads 'OFFICIAL STATE FUND DOCUMENT" PRINTED: 06 -10 -2005 <br />PAGE 1 OF i <br />