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CERTHOLDER 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: 01-01-2005 GROUP: <br />POLICY NUMBER: 0803615-2005 <br />CERTIFICATE ID: 62 <br />CERTIFICATE EXPIRES: 01-01-2006 <br />01-01-2005/01-01-2006 <br />CITY OF SANTA ANA SG <br />S D 37 <br />20 CIVIC- CENTER PLAZA14, <br />SANTA ANA CA 92701 <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 />(REV.3-03) <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 other document <br />with respect to which this certificate of'.. insurance may be 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 />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY: LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE .01-01-2005 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />JOHNSON-FRANK & ASSOCIATES <br />5150 E HUNTER AVE <br />ANAHEIM CA 92807 <br />LEGAL NAME <br />JOHNSON-FRANK & ASSOCIATES <br />(A CORP) AND/ <br />PRINTED: 12/17/2004