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<br />SP <br /> <br />p, ..CYHOLDER COpy <br /> <br />STATE; po. BOX 807. SAN FRANCISCO,CA 94142~0807 <br />COMPSN!;AT10.N <br />IN!; U ~ A N CE <br />FUN D CERTIFICATE OF WORKERS' COMPENSATiON INSURANCE <br /> <br />ISSUE DATE: 05-30-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 0355209-2004 <br />CERTIFICATEID: 117 <br />CERTIFICATE EXpiRES: 05-30-2005 <br />05-30"2004/05-30-2005 <br /> <br />CITY OF SA'ITA {l'lA <br />ATTN CARLA THOIIPKINS <br />PO BOX 1988 lI-a5 <br />SANTA ANA CA 92]02 <br /> <br />SP <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. <br /> <br />We will also give you 30 days' aiiyarlce notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certific~tebf-:-insur"rcej$n6t.an in~urance policy and does not amef'1d,ex1Emd' or alter the c(>verage afforded <br />by the poJid~s listed herein,Notwithstan~~jing any' r-equif'.em~t1t. term, or conditiori of any cOntract Or other document <br />with respe?t 'to which this certificate of' insurahce mayh~ issued or may pertain, the insurance afforded by the <br />policies des:cribed herein is subject to all t~e term~, excl~iors and conditiO[l.s of such policies. <br /> <br />~ <br /> <br />A~{! <br /> <br />~ <br /> <br />AUTHORIZEOREPRESE;NTA TIVE PRESIDENT <br /> <br />EMPLOYER'S LJA!lJLITY LIMn INCLUOIIoIG DEFENSE COSTS: $1,000 .000.Q(f PEll OCCURRENCE. <br />E!illl(lR$EMENT 1i2~5 ENTI'rL~O CeRTIFICA.1'E HOLDERS' NbncEEFFECTIVE ~-~1,l-2oQ4IS ATTACHED 1'0 ANO <br />FORMS A PART OF THIS POLICY. <br /> <br />APPROVED AS TO FORM <br /> <br /> <br />EMPWYER <br /> <br />LEGAL NAME <br /> <br />ORANGE COU'ITY A1R <br />HOUSI'IG COUNCI <br />201 S BROAOWA Y <br />SA'ITA ANA CA 92]01 <br /> <br />ORANGE COUNTY FAIR HOUSING COUNCIL <br />(A NON-PROFIT CORP.) <br /> <br /> <br />.. <br /> <br /> <br />. :. <br /> <br />. <br /> <br /> <br />04/lIU20<l.4 <br />. . <br />