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<br />OCT. 10. 2001 10:47AM <br /> <br />S~ COMP INSURANCE <br /> <br />.-NO. 6360-P. 1/1 <br /> <br />- <br /> <br />"-..-/ <br /> <br />........ <br /> <br />STATE <br />OOMI'EI4SAT'ON <br />.NS....."NCIlii <br />FUND <br /> <br />P.O. BOX 4201107, SAN FRANCISCO, CA 94142-0807 <br /> <br />CERTIFICATE OF WORIU!RS' OOMPENSATION INSURANCE <br /> <br />Oe1OlER 10, \!(IO 1 PDUCV NI.IMBS.., <br />CERlmCATE ExPI~IlS: <br /> <br />1298310 - 01 <br />6-1-Q2 <br /> <br />r <br />CITy Of' SANTII ANA <br />WOR~E~S COMP CLAl~S DEPT <br />~o crvte C.NTER PLAZA ~-41 <br />SANTA A~ CA ~2?Ol <br /> <br />L <br /> <br />Thlo Is to certify that we i'l8ve issued a vallo Workers' Compensation insurance policy in a form approved by the Califomia <br />Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />Thi. policy Is not subject 10 C;lnoellalion by the Funo """"pt upon ten days' advance writt,," notice to tho employer, <br /> <br />We wHl also give you TEN 1111)'0' eO",,"oo notice ohoulll thl. policy 00 cancelleO prlO,lo its normal tntplralion. <br /> <br />This o.(liflcate of insurance is not In I~rance pol k;y and does nOt amend, 1OO8no 0' alter l"e co""....ll" affOrded by the <br />polici"" lioIe<I he",ln, NOIWllMlanding any ruQuilemenl, term, or condition of any contract or other document ~h <br />I'8llpet:! to which !hi. oerl~l~le 01 insurance may bo /seued Or may Porqin, the ins"ranoe affOniod by the polic~ <br />d.""lbeCl nereln is subJet:! to all th'terms, excluslol'lS and conditi"". of euch OOlicies. <br /> <br />~~,,-.-d~ <br /> <br />AUTHORIZec AEiP~=E <br /> <br />K~ <br /> <br />[MP~OYER'S ~IAEILITY lIMIT INCLUDING DEFE~E ~DSTS, 11,000,000 PER OCCURR"NG[. <br /> <br />P~t;!:=m~eNT <br /> <br />eMPl.QVEA <br /> <br />r <br /> <br />APPROVED AS 1U l"UK1VJ <br /> <br />~IEN ON /IE me <br />p 0 BO:< 9163'0 <br />PASADEMA CA 9110? <br /> <br /> <br />L "~m~ <br />