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CERTHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 11-14-2016 <br />CITY OF SANTA ANA SP <br />MS. SILVIA CUEVAS <br />20 CIVIC CENTER PLZ # M-16 <br />SANTA ANA CA 92702 <br />GROUP <br />POLICY NUMBER: 1315218-2015 <br />CERTIFICATE -10: 241 <br />CERTIFICATE EXPIRES: 07-01-2017 <br />07-01-2015/07-01-2017 <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 30days 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 />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - GAYLE BLOOMINGDALE PRES,SEC,TRES - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1989 IS <br />® ATTACHED TO AND FORMS A PART OF THIS POLICY, <br />EMPLOYER <br />COMPREHENSIVE HOUSING SERVICES, INC. SP <br />8840 WARNER AVE STE 203 <br />FOUNTAIN VALLEY CA 92708 <br />[MBO,CS] <br />SP <br />.0 <br />06 <br />j(00 <br />(REV.7 20 14) PRINTED : 11-14-2016 <br />