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<br />SC <br /> <br />'-' <br /> <br />......,. <br /> <br />A--2~2-165 -2- 3 <br />4- "2OeIl~ 6<6lj -if <br />A--MO{ ~07~ <br /> <br />STATE <br />COMP.....SA'l'ION <br />INSURANCE <br />FUND <br /> <br />P.O. eox a07, SAN FRANCISCO,CA l3410 1-0807 <br /> <br />CERTIFICATE PF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 01-01-02 <br /> <br />POLICY NUMBER: 1464277 - 02 <br />CERTIFICATE EXPIRES: 01-01-03 <br /> <br />MS. DORIS TURLEY <br />CHY Of SANTA ANA <br />20 CIVIC CENTER PLAZA <br />PO BOX 1988 . <br />SANTA ANA CA 92792 <br /> <br />This is to certify that we have issued a valid. Workers' Compensation insurance policy in a form approved by the <br />California l'nsurance 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 YOl.!'30days'ad'iiance notice should this policy be cancelled prior to it~ .normal. expiration. <br /> <br />This certif:icate ':-of.:insu~"nc::.~isnotan ins~rance policy and does not al'Y1snd. extend or alter the coverage afforded <br />by the ppliqies listed here,in~__N_otwIthstandir1g 8nyr~qu.iIement, term. or condition Of any contractor other docum,en,t <br />with respect to which this' certificate of i"sursr"cemaY"bs_issued or may- pe~tain; the insurance afforded by the . <br />policies described herein is subject to all_the terms. exclusions and conditions -of such policies. <br /> <br />.J/ r/ ~ <br /> <br />~isIDENT <br /> <br />EMPLOYE!,! 's LIABILITY LIIo!IT INCLUDING DEFENSE cc)STS: $1,000,000.00 PER OCCURRENCE. <br />ENDO~SEMENT#2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01/01/02 IS ATTACHED TO AND <br />FORMS A PA~T OF THIS PO~ICY. <br /> <br />~;TO F~:M <br /> <br />Laura l1eedy. .... <br />[leputy City Attorney <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />LUTHER~ SOCIAL $VC. OF SOUTHERN <br />CALIFORNIA <br />1501 E ORANGETHD4PE AV~ <br />FULLERTON CA 82831 ' <br /> <br />LUTHERAN SOCIAL SERVICES DF SOUTHERN CALIF <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF "265 (REV 201) <br /> <br />PRINTED- <br /> <br />12C18-01 <br /> <br />P0408 <br />