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<br />. .,1 <br /> <br />",'-" <br /> <br />""" <br /> <br />".,'" <br /> <br />I <br />, <br />I <br />I <br /> <br />STATE <br />COMPENSATiON <br />INSURANQ-E <br />FUN.D <br /> <br />P.G. BOX 420807, 'lAN FRANCISCO, C,A 94142.0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />-"" :,," ... <br />. ' <br /> <br />JULY 3, 2002 <br /> <br />POLlCV NUMBER: <br />CERTIFICATE EXPIRES, <br /> <br />1638989 - 02 <br />7-1-03 <br /> <br />I <br /> <br />CITY OF SANTA' ANA ' <br />roMMUNI'l'Y DBvEtoamrx AGENCY1t-25' <br />P.O. BOX 1988 <br />SANTA ANA CA 92702 <br /> <br />L <br /> <br />l <br />I <br />-\ <br />I <br />I <br />, <br />I <br /> <br />ThiS IS to certify that we have issued a valid Workers' Compensation fnsurance policy in a form approved by the California <br />Insurance Commissioner tathe empioyer named b~""oIiCYfleTiO'ctind!(;"ted: .. ..."~ ,..- ' .... ...' <br /> <br />This policy is not subject to cancellatIOn by the Fund except upon tl!.Qdays' advance written notice to the employer. <br />XX ' <br /> <br />We will also give you 'flO.J daYs' ad~~nce notice should thiS po_cy be cancelled prior to its normal expiration: <br />XX, . <br /> <br />This certificate of insurance is not ,In insurance 'policy and does not amend, extend or alter the coverage afforded by the <br />policies listed herElin. Notwlthstan<;iing any ,requirement, term, or condition of any contract or other document .with. <br />respect to ,which thiS certificate 'of insurance m'!"'" QIi issl;Ejd or may pertain, ,.the- insurance afforded oy; the policies. <br />described herein is subject to all the terms,.exclusions a,nd cona~ions of such policies. .,' <br /> <br />: <br /> <br />;7~~~ <br /> <br />AUTHORIZED 'REPRESENTATIVE;' <br /> <br />K~ <br /> <br />PRESIDENT <br /> <br />. <br />mfillDYER'S LIABILITY UMIT,INcuIDING~iCX?STS: $1,000,000 PER~. <br />ENOORSEMENT 12065 mlnlD CERrIFlcATE HOLDiRS'NarICK EFFECTIVE <br />07/01/02 IS AttACHED TO AND FElRMSA'PARl' OF THIS POLICY'. . <br /> <br />"'PR~ TO ",,,,,, <br />", ~ 2... - <br /> <br />:.;.... 'ORIS" ...-.:. U;w <br />.. .... ''''Y Attorney <br />Oel)\.I.. "" '" " <br /> <br />EM PLOVER <br /> <br /> <br />l~u.lQnV All;) Atnil~a <br />. '. AP~~~r' <br /> <br />.,~ <br /> <br />. . W1lQd ()J: sv IT~AOll<lJ'Y . <br /> <br />''',' <br /> <br />I <br /> <br />FEEDBACK FOUNDATIoN INC <br />1200 N KNOLUlOOD CI1~' <br />ANAHEIM CA 92601' , <br /> <br />,'\ <br /> <br />, <br /> <br />$~1t1, <br /> <br />