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POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94568 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-06-2018 <br />CITY OF SANTA ANA SP <br />1000 E SANTA ANA BLVD STE 200 <br />SANTA ANA CA 92701-3900 <br />GROUP: <br />POLICY NUMBER: - 1375240-2015 <br />CERTIFICATE - ID: 1 <br />CERTIFICATE EXPIRES: 10-01-2016 <br />10-01-2015/10-01-2015 <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 ttthJee policy described <br />ooliiccydescribed herein is subject to all the terms, exclusions, and conditions, of such policy. <br />Authorized Representative/% President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />ORANGE COUNTY LABOR FEDERATION, AFL-CIO (A <br />LABOR UNION) C/O , AFL - CIO <br />309 N RAMPART ST STE A <br />ORANGE CA 92868 <br />SP <br />[MON,SCj <br />(REv.7-2074) - PRINTED : 01-06-2016 <br />