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<br />- <br /> <br />-. <br /> <br />'-' <br /> <br />'wi <br /> <br />STATE <br />COMPENSATIQ,N <br />INSURANCE <br />FUN.O <br /> <br />P.O BOX 420807, SAN FRANCISCO, CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS'COMPENSATlON INSURANCE <br /> <br />,1UL Y 8, 2002 <br /> <br />POLICY NUMBER; <br />CERTIFICATE EXPIRES: <br /> <br />1638989 - 02 <br />7-1-03 <br /> <br />,- <br />CITY OF SANTA ANA <br />ATTN COMMUNITY DEVELOPMENT AGENCY M-25 <br />POBOX 1988 <br />SANTA ANA CA 92702 <br /> <br />L <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California <br />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 ten days' advance written notice to the employer. <br /> <br />We will also give you TEN days' advance notice should HllS policy be cancelled prior to its normal expiration. <br /> <br />This certificate ot insurance is not an insurance policy and does not amend, extendor alter the coverage afforded by the <br />poliCies listed herein. Notwithstanding anyrequirernl?nt _term, or conditionaf,any contract or Other document with <br />:respect to'which this certificate of insurance may be iss:ueci or may pertain,the insurance afforded by the policies <br />desqibed herein is subject to all the terms, exclusions and conditions of such policies. <br /> <br />?7~~~ <br /> <br />AUTHO R I ZE DR E PR ES ENTA TI VE <br /> <br />I(~ <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCUf\RENCP <br /> <br />EMPLOYER <br /> <br />FEEDBACK FOUNDATION INC <br />1200 N KNOLLWOOD CIRCLE <br />ANAHEIM CA 92801 <br /> <br />APl~JWVBD AS TO FORM <br /> <br />-~~~'cIV( <br /> <br />,I C.rv /\Horney <br /> <br />,- <br /> <br />1_ <br /> <br />.~12HI <br /> <br />THIS DOCUMENT,HAS A BLUE PATTERNED BACKGROUND selF 10262 (REV 5-01) <br />