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<br />06/29/?006 14:24 <br /> <br />714-567-7474 <br /> <br />DC HUMAN RELATIONS <br /> <br />PAGE 02 <br /> <br />CERTHOLDER COPY <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />.NSYFlANCE <br />FUND <br /> <br />P.O. BOX 420907. SAN f'RANCISCO,CA 94142,-0807 <br /> <br />CERTIFICATe OF WORKeRS' COMPENSATION lNSURANCIi <br /> <br />'X5SUI DATE: 00-1~-2000 <br /> <br />CITY OF SANTA ANA <br />20 CIVIC CENTE~ pLZ M-37 <br />SANTA ANA CA 92701-COSB <br /> <br />SP <br /> <br />~OUP: . <br />POl.lCY NUMBeR: 137S21B-200S <br />CERTIFICATE 10: 28 <br />CERTIFICATE EXPIRES: 1o-01-200G <br />10-01-200S/10-01-2008 ~ <br />THIS CERTIFICATE SUPERSEDES AND CORRECTS <br />CERTIFICATE , 24 DATED OB-22-2ooS <br />~D:DISpUTE ~ESOLUTIDN P~OGRAM <br /> <br />this: is to C811ify thft we h0Pl8 Iss~.d a valid Workers' CQI1'IpensaUOr'l ihtUfllncG policy in a form' i1pprond by the <br />Csliforrlia Insurance COmrn1"ioner to the etmplovBl' nlmed below. for the ~olicy period Indicated. <br /> <br />1'hiS policy is not liubjoet to c:anc>.tllatlon' by th. Fund 8XCGpt . upon 10 d8'fs ~"CB written nQtk:s to th~ E!Jl'r'Iployer. <br /> <br />We will atao giva you 10 d~ BtN.ance notte. should this polley be caneellod prior to Its ~or~1 expiration. <br /> <br />This cliitrtifiQSt.e Qf insu'~ce Is nct an ir:rs;urance poUcy and. does. not amend. 8xtond or alter tho covongo' ~fforded <br />by the poUcy listed heraln. .Notwl'thstlndinSl :I'(If requireMent. term or condition of any contract or othar dOCUMent <br />with ("",pect to whttlh thts c::ertifi(J:KfilI of fnsur.anee may bel Issued or to which tt may pSrtaln. the lnsur;T'1co <br />sfto~dBd by the policy described ~.r.ln 18 subject to aR the torrns, s)(clualons. and conditions. of such polley. <br /> <br />Q::R:=ZS <br /> <br />EMPLOYER'S LIABIUTY LIMIT INCLUDINIil <br /> <br />~ <br /> <br />PRESIDENT <br />llCFENSE COSTS: $ 1.000.000 PER OCQIRRENCE. <br /> <br />'-~-------- <br />/'-f/'._~~~..5' <br /> <br />EMPLOVER <br /> <br />ORANllE COUNTY HUMAN RELATIONS COUNCIL (A SP <br />NON-PIIOF%? CORPO~ATION) C/O COUNCIL <br />1300 S "RANO AVE ST' II <br />SANTA ANA CA 92705 <br /> <br />IREV.2-0S1 <br /> <br />PRINTED <br /> <br />ISJW,CNj <br />08-13-2008 <br />