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. . SC STATE COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 ZOtJ6 ~ /tf I CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICY NUMBER: 1298310 - 02 CERTIFICATE EXPIRES: 06-01-03 -- 1>c'i>67891 ,:" ";'7 " i':J .! ~ \ ~~ ,,, ~~I;'),. '$. ;0 ,,:" '\" eO. ....a I'''' ... e'..J. "'~~~ 1J1 \ 'A n. e,~, s~~'\<I'~'!i c; " <P. ~",\ "_,~~~q) :::: \~~ \) ::t-w N '.;:" "',C <l3 ~\~~ A~ -",-t.'>- t"'\" .~:~.to> ' l,"0,:// .~, ... rz 1Z .- This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved'1)y"1fie-~" California Insuranctl Commissioner to th~ employer named below for the ~olici peiiod indicated. ISSUE DATE: 06-01-02 CITY OF SANTA ANA WORKERS COMP CLAIMS OEPT 20 CIVIC CENTER PLAZA M-41 SANTA ANA CA 92701 This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of . insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirem~nt, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ~IDE~ EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #20B5 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08/01/02 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ., .r, \.()Rwl APPROVED A:"> 1 . .. ------.' EMPLOYER LEGAL NAME LIEN ON ME, INC. ) PO BOX 91830 '-~:~ LIEN ON ME, INC. 05-18-02 .. : -, . :. - . .