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POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 945$$ <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-01-2016 <br />CITY OF SANTA ANA <br />ADMINSTRATVIE SERVICES DIVISION M-25 <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 62701-4088 <br />SP <br />GROUP <br />POLICY NUMBER: 9023428-2016 <br />CERTIFICATE 10: 15 <br />CERTIFICATE EXPIRES: 09-01-2017 <br />09-01-2016109-01-2017 <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 />affordedby the <br />jppollliiccydescribed <br />f herein Is subject to all the terms, exclusions, and conditions, of such policy. <br />"'/\ <br />I 4� <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PEOPLE FOR IRVINE COMMUNITY HEALTH (A SP <br />NON-PROFIT CORP.) DBA: 2-1-1 ORANGE COUNTY <br />1508 E 17TH ST STE 108 <br />SANTA ANA CA 62705 <br />[JL8,CSI <br />iaEV.7-2014l PRINTED : 11-15-2016 <br />SP <br />