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1: 54PH <br />NO. 6 11 P. 1/2 <br />CERI ATE HOLDER COPY <br />STATr= P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPIVNSATION <br />IN ZU R A N C E <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />MAY a, 2002 GROUP: <br />POLICY NILIIVISER: :635002-2002 <br />CERTIFICATE 10, 2 <br />CERTIFICATE EXPIRES: ,ea, <br />C-TY or $AI\YTA ANA <br />COMMUNITY DEVEOP AGENCY <br />PO BOX 2988 M25 <br />SANTA ANT. CA 92702 <br />This is to certify that we have ISSLOd 2 valid Worker's Gompansaijor in6uranp9 policy in a form npproveq by the California <br />Insurance Comriissionerto the amployernamed belowforthe policy period indicated, <br />This policy Is not suloiect 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 thlf, Policy be cancelled prior to its normal expiration. <br />71tIis coffcate of Insurance Is not an insuranQ9 policy anddoes not ameno. extend or alter the coverage afforciod by the <br />polleeslisted heroin. Notwithstanding any requirement, term or condition of any contrMot or other document with <br />respsct to which this certificate of insurance rray be Issued or may pertain, the Insurance afforded loy the policies <br />described herein I-* aJbiaot to all the terms, exclusions, and ccnditions, of such P006s. <br />AUTHORIZED REPRESENTATIVE <br />EMPLOYMRI S L:AB!L7TY LTYTT TNCLTMWG nFPENSE CCSTS: $1, 00D, 000 PER OCCUPIRENC7 <br />FtOPLOYEA <br />PRIENI)SRIP !:13ELTER INC <br />PO BOX 4252 <br />­kGUNA BRACE CA 92652 <br />ARRRfi <br />OVED AS 1.'0 1"ORM <br />I I Air, I S 1�1 <br />,Jra S I edy <br />Deputy CRY Attor11ey <br />SCIF 10265 [EPF-Ul: 511 <br />