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.l uv- Z(- Ztajl, lid;-10 1 Flt URMBUD 1 RN FAMILY 714 571 1974 <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />COMPENSATION <br />1NSUPtANCE <br />FUND CERTIFICATE OF WORKERS COMPENSATION INSURANCE <br />ISSUE DATE: 00 -30 -2000 GROUP: <br />POLICY NUMBER 1000070 -2000 <br />CERTIFCATE Ok 3 <br />CERTIFICATE EXPIRES 00-30 -2007 <br />00-30- 2000/00 -30 -2007 <br />CITY OF SANTA ANA <br />PO sax less <br />SANTA ANA W 02702 <br />Sc RECEIVED MAY Y 5 200, <br />This Is to certify that we have Issued a valid Workers' Competwation Insurance policy in a form approved by the <br />Ca1HOrnia 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 10 days advance written notice to the employer. <br />We will also give you 10 drys 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 listedherein Notwithstanding arty requirement, term or condition of arty 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 />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />THE CAMBODIAN FAMILY SC <br />1111 E MAK9HAM AVE STE E <br />SANTA ANA CA 92700- <br />MEV.2 -05) if . ;i PRINTED : 05-17 -2000 <br />P. 02/02 <br />TOTAL P.02 <br />