<br />/"., ".....
<br />
<br />.
<br />
<br />l~:-'\
<br />
<br />-,.',
<br />
<br />~,
<br />..."'.;;':"""
<br />j-' :-<""-,. '
<br />'STATE
<br />cOMPsilsATlot.
<br />IN SUR'AN C'E
<br />FUND
<br />
<br />.
<br />
<br />c~.
<br />
<br />. ';,::,;;;\.~I,;
<br />
<br />~::.:,,:'
<br />
<br />:-.-SC .~":',:;
<br />:",:,. ~:.
<br />
<br />,'.N~
<br />
<br />,{ ," .
<br />1,"~'J~
<br />~ .
<br />p,O, Sox 80y, SAN FRANCISCO.CA 94101....0'807
<br />
<br />
<br />CERTIFICATEl:)F, WORKERS' COMPENSATION INSURANCE
<br />
<br />" ., ,~
<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 />CHYOfSANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />PO BOX 1988
<br />SANTA ANA CA 92702
<br />
<br />""; .. ';
<br />
<br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
<br />California Insurance Cornmission,ar to the employer n.med below for the polic'{ period :ndicatcd.
<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 you-30 --days' . advance notice should this policy be cancelled prior to its normal expiration.
<br />
<br />-, .....-:'--t : ,_": :,: - .~
<br />This C~fti't:i_cate,'oL insurar'IC_e is pot an insurance policy and does not arryend. extend: or alter thE! coverage afforded
<br />.bythe pplicies Ii,~ed hereIri,"__:Notwithstanding any,,reguirEl_ment. term, or condition pf any contract or other document,
<br />with resp~ctto,which this"certificate of ipsura!1ce.'J:oaV_be,issued or may,pertai~; the insurance afforded by the~"''':,''
<br />policies described herein is subject toal! ~the ~erfT1s, exclusions and conditions ,of such policies.
<br />
<br />~IOE~
<br />
<br />'EMPLOYER'S LIABIL)'=Y LI~IT INCLUOING OEFE,:!SE cpSTS: $1.900.000.00 PER OC;CURRENCE.
<br />\ ENOO~SEMENT#2065 ENTtTLEO CERTIFICATE HOLOERS"NOTICE EFFECTIVE 01/01/02 IS ATTACHEO TO ANO
<br />. \FOR)lis A PARTOF'THIS POLICY
<br />.~..,
<br />
<br />
<br />...
<br />
<br />EMPLOYER
<br />
<br />LEGAL NAME
<br />
<br />.
<br />
<br />LUTl-iERANSOCIAL $VC.pF SOUTHERN
<br />,'CALIFORNIA '
<br />1501 E ORANGETHO~PE AVE
<br />FULLERTON CA 92831
<br />
<br />LUTHERAN SOCIAL SERVICES OF SOUTHERN CALIF
<br />
<br />:"',--,.'.
<br />
<br />:j,"
<br />,
<br />i'-..';.,
<br />.
<br />
<br />-~,
<br />
<br />~
<br />
<br />
<br />.:11..."111.1.111.11'11:::1 ~I. :r.""....:tI:t..I=-:.r:.:'I..::I:h~I:::I.I:~\II~(C1:{.1.h'lII
<br />
<br />. .' 1Z" 18-.01
<br />PRINTED: ',,' :PO~W8
<br />.....I~III'J;!......:I:a._..aI)1
<br />
|