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<br />CERl ..,-oLDER COpy <br /> <br />NF <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />I=UND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142.-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 07-17-2006 <br /> <br />GROUP: <br />POLICY NUMBER: 1768237-2005 <br />CERTIFICATE 10: 5 <br />CERTIFICATE EXPIRES: 11-11-2006 <br />11-11-2005/11-11-2006 <br /> <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT AGENCY-M-25 <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br /> <br />NF <br /> <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 /> <br />This policy is not subject to c...cellation by the Fund except upon30 days advance written notice to the employer. <br /> <br />We will also give you 30 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. Notwithstandin~ tIIly requirement, term or condition of tIIly contract or other document <br />with respect to which this certificate of Insurance may be issued or to which it may pertain, the insur...ce <br />afforded by the policy described herein is subject to all the terms, exclusions. and conditions, of such policy. <br /> <br />a::-R~ <br /> <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE <br /> <br />~ <br /> <br />PRESIDENT <br />COSTS: $1 .000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT 12065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-11-2004 IS <br />ATTACHED TD AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br /> <br />REBUILDING TOGETHER ORANGE COUNTY (A <br />NON-PROFIT PUBLIC BENEFIT CORP ) <br />PO BOX 329 <br />TUSTIN CA 92781 <br /> <br />NF <br /> <br />"'~~"._' <br />~~~ <br /> <br />(REV.2-05) <br /> <br />[JD4,CN] <br />PRINTED 07-17-2006 <br /> <br />