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<br />STATE <br />COMP',NSA1"IO,.., <br />INS Ul" '" N CE <br />FUND <br /> <br />, SP <br />~ ~lTHOLD~R COpy <br />p,O, s,bX aot SAN FRANCISCC);CA94142-0S07 A.-.J([J:)/lor---6/ <br /> <br />'. ~. . . <br />CERTIFICATE (IF ;WORKERS'COjVIPENSATIOl\l"INSURANCE <br /> <br />ISSUE DATE: 12-01-2001 <br /> <br />'CITY Of SANT~ ANA <br />COMMUNI TV OEVE:LOP/'IENT & <br />20 CIVIC CENTER PLAZA <br />SANTA ANA <br />CAL I FORN I A 92101 <br /> <br /> <br />GROUP: <br />POLICY NUMBER: 1572188 - 2002 <br />CERTIFICATE 10: 2 <br />CERTII'ICATE EXPIRES: 12-01-2OQ3 <br />12-01-2002/12-01-2003 <br /> <br />.J08: ALL OPERATIONS <br /> <br />OURI S TURLEY <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California (nsurarv;e Commissioner to the emplovernamed betow for the .polky p$riod indicJlted.' <br /> <br />This policy is not subject to cancellation by the Fund except upon 10 days' advance written notice to the employer. <br /> <br />We will also give YOu:'10days'-aqvance notice should this'potlc::.v be ,cancelled prior to its norrnaf":ceikpiration. <br /> <br />This cartifipate, of}(nsJr~nc.,is,pot __.h if'l$L,I~lInce polic~. and, does "n,tit' ame:nd~ ex'tend'oralte~ thEi!t()vera~e afforded <br />by the ~Iicie~ listed herein.~Q.twithstanpin~anv", r::,lfqVir~m,~nt. term, or conditiQ!M 9fany contntct or other qocurryent <br />with respect: to ,which this certificate of insuran~e,maV-':Qe"J~suedor may ~per~in. thei,nsurance afforded by the <br />policies d~crlbed herein is subject to all ~e t~m~; '-e'xe,I:Y$iqns and conditi,?ns ,Of such policies. <br /> <br />/,4:.~o <br /> <br />- <br /> <br />~~ <br /> <br />PRESIDENT, <br /> <br />AUTHOR I ZEDREPRESENTA TlVE <br /> <br />EMPLOYER'S ~IABU.ITY LIMIT INCLUOINCl OEFENSE cons,; <br /> <br />;- ".:' ~,:-: <br />$1,600.009.00 PER' OCCU/lRENCE. <br /> <br />AS TO FORM <br />APPROVED , <br />i~' <br />citY Altotn-Y <br />DepUtY <br /> <br />EMPLOYER <br /> <br />PAULi'lCNEFF SilNGERS. INC~ <br />(A NON-PROF Ilt::ORI1),; , <br />3947 E LA PALMA AVE; <br />ANAHEIM CA 92807 , ; <br /> <br />B: ~ . B, ' . .: <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF ,Ulbc. (ReV 201) <br />