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<br />CERTHOLDER COpy <br /> <br />STATE <br /> <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 10-01-2007 <br /> <br />GROUP: <br />POLICY NUMBER: 0720294-2007 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 10-01-2008 <br />10-01-2007/10-01-2008 <br /> <br />fI/ -- cQ Cf...,lb -- () :> .3 <br />f'/- ;lOC)(, U~) J -'\) I <br /> <br />CITY OF SANTA ANA <br />AnN: CITY CLERI< <br />PO lOX 1188 <br />SANTA ANA CA 12702-1188 <br /> <br />SP <br /> <br />ThiS IS to certify thllt we hlllle Issued II IIlIlId Workers' Compensation Insurance policy In a form appro lied by the <br />ClIllIorn'lI Insurllnce Commissioner to the employer named below for the policy penod indicated <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 III so give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />ThiS certificate of Insurance is not an insurance policy and does not amend. extend or alter the coverage afforded <br />by the POliCY listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the Insurance <br />afforded by the pOlicy described herein is subject to all the terms. exclusions, and conditions. of such poliCY. <br /> <br />C1:::-REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~~~~- <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1700 - MARTHA ARGUELLES - EXCLUDED. <br /> <br />ENDORSEMENT #1700 - PATRICIA FITZGERALD - EXCLUDED. <br /> <br />ENDORSEMENT #1700 - SALLY M. LOW - EXCLUDED. <br /> <br />nS2 <br />r--l <br />rrl-( <br />:;rJ ..-"'" <br />:!!:~" ." ,,' <br /> <br />~ <br /> <br />"'" <br />...,., <br />-0 <br />N <br />........ <br /> <br />;""-.... <br />......-..' <br /> <br />.."",,~ <br />'---'j:..' <br />:z- ~ <br />nJ:> <br />--r <br />r-'); <br /> <br />>- <br />:z: <br /><;;> <br />N. <br />..&::I <br /> <br />EMPLOYER <br /> <br />MARTHA ARGUELLES, AND SALLY M, LOW AND SP <br />PATRICIA FITZGERALD DBA: BROZEY, LOW & <br />ARGUELLES <br />600 W SANTA ANA BLVD STE 208 <br />SANTA ANA CA 92701 <br /> <br />(REV.2-051 <br /> <br />PRINTED <br /> <br />09-17-2007 <br /> <br /> <br />SP <br /> <br />M0408 <br />