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CERTHOLDER COPY STATE COMPENSATION INSURANCE FUND P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-28-2007 GROUP: POLICY NUMBER: 1610814-2007 CERTIFICATE ID: 76 CERTIFICATE EXPIRES: 03-28-2008 03-28-2007/03-28-2008 CITY Of SANTA ANA ATTN: MIKE LINARES ESQ-CDA PO BOX 1988 M-25 SANTA ANA CA 92705 SP uOB:ALL CALIfORNIA OPERATIONS A- ;;).()Of.t, - () &; 2 -A.. ;J.cc Co - tt'l;:t - 0 '.Ft This is to certify that we have issued a valid Workers' Compensation insurance policy in i form approved by the California lnsur anee Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the poliCY listed herein. Notwithstanding any requirement. term or condition of any contract or other document with respect to whIch this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms. exclusions. and conditions. of such policy. 6::: REPRESENT A TI EMPLOYER'S LIABILITY LIMIT INCLUDING DEfENSE COSTS: ~ PRESIDENT $1,000,000 PER OCCURRENCE. ENOORSEMENT #2065 ENTITLED CERTIfICATE HOLDERS' NOTICE EffECTIVE 03-28-2007 IS ATTACHED TO AND fORMS A PART Of THIS POLICY. EMPLOYER A,riR.(}VED !~~; TC) FORM L~if!r: S="Cdy As..J.SEa.1t City Attcrr.cy WOMEN'S TRANSITIONAL LIVING CENTER, INC SP PO BOX 6103 ORANGE CA 92863 (REV.2-05) PRINTED 02-17-2007 e.. P, SP M0408