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' IRTHOLDER COPY <br />STATE P.O. BOX 807♦ SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE _ ... <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07-01-2003 <br />CITY OF SANTA ANA SP <br />COMMUNITY DEV.:AGENCY M-25-DORIS A TURLEY <br />P.O. BOX 1988 <br />SANTA ANA <br />CALIFORNIA 92702-1988 <br />GROUP: 000469 <br />POLICY NUMBER: 0001646-2003 <br />CERTIFICATE ID: 15 <br />CERTIFICATE EXPIRES: 07-01-2004 <br />07-01-2003/07-01-2004 <br />JOB: ALL OPERATIONS <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 30 .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 policies .listed herein.„ Notwithstanding any requirement term, or condition of any contract or otherdocument, <br />with respect to which this certificate of-Jn4urance maybe issued or may pertain, the insurance afforded by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. , <br />c . 64L <br />AUTHORIZED REPRESENTATIVE PRESIDENT:. <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2003'IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. - <br />EMPLOYER <br />LEGAL NAME <br />MARIPOSA WOMEN'S CENTER, INC. MARIPOSA WOMEN'S CENTER, INC. <br />812 W MOWN AND COUNTRY RD (A NON-PROFIT CORP.) <br />ORANGE CA 92868 <br />(REV.3-031 .06-18-2003 <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND <br />