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CERTHDLDER CA°Y <br />STATE P.O.80X 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03-01-2006 GROUP: 00pggg <br />POLICY NUMBER: 0003587-2005 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 03-01-2007 <br />03-01-2008/03-01-2007 <br />CITY OF SANTA ANA Sp <br />COMMUNITY DEVELOPMENT AGENCY <br />20 CIVIC CENTER PLAZA M25 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 70 days advance written notice to the employer. <br />We will also give you 70 days advance notice should this policy be cancelled prior to its normal expiration. <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 />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $7,000,000 PER OCCURRENCE. <br />EMPLOYER <br />BLIND CNILDRENS LEARNING CENTER Sp <br />18542 VANDERLIP AVE STE B <br />SANTA ANA CA 92705 <br />C~~~ <br />~_/~:~ASG ~'O FORM <br />G!.~L-Lg~1_ <br />~. ,t SP.c,ady T-- <br />-. ~: .:y Atlocey <br />SP <br />MoaoB <br />(REV.]-05) PRINTED 02-18-2006 <br />