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<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 />