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POLICYHOLDER COPY SG <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />•INC r U N D CERTIFICATE OF WORKERS'. COMPENSATION INSURANCE <br />ISSUE DATE: 01-01-2008 GROUP: <br />POLICY NUMBER: 0809618-2008 <br />CERTIFICATE ID: 16 <br />CERTIFICATE EXPIRES: 01-01-2007 <br />01-01-2008/01-01-2007. <br />CITY OF SANTA ANA so <br />BUILDING 8 SAFETY DEPT <br />PO BOX 1988 <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 30 days advance written notice to the employer. <br />We will also give you 30 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. Notwithstandin?I any requirement, term or condition of any contractor other document <br />with respect to which this certificate of surance 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 />A,;,,t C . <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 81800 - ROGER FRANC, PRES - EXCLUDED. <br />ENDORSEMENT #11700 -. ALAN FRANK, S,T EXCLUDED. - <br />ENDORSEMENT 82088. ENTITLED CERTIFICATE. HOLDERS' NOTICE EFFECTIVE 01-01-2002. IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />*HNSON-FRANC a ASSOCIATES (A CORP) AND/ SG <br />DBAWOHNSON-FRANK 8 ASSOCIATES <br />6160 E HUNTER AVE <br />ANAHEIM CA 92807 <br /> <br />M0410 <br />(eEV.4-06) PRINTED : 12-17-2008