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~_Zoo(o-Z~ `~ <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 11-18-2007 <br />CITY OF SK <br />SANTA ANA <br />220 5 DAISY AVE <br />SANTA ANA CA 92703-4334 <br />GROUP <br />POLICY NUMBER: 1478909-2007 <br />CERTIFICATE ID: 188 <br />CERTIFICATE EXPIRES: 04-01-2008 <br />04-01-2007/04-01-2008 <br />This Is +o certity that we have issued a valid Workers' Compensation insurance pclicy 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 certitica[e 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 6e issued or to which it may pertain, the insurance <br />afforded 6y the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />THORIZED REPRESENTATI <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 81,000,000 PER OCCURRENCE. <br />ENDORSEMENT N1600 - ANDRE HARPER, VP - EXCLUDED. <br />ENDORSEMENT N1800 - KRISTA HARPER, TRES - EXCLUDED. <br />ENDORSEMENT k2088 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2005 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />Y~ <br />EMPLOYER <br />HARPER & ASSOCIATES, INC. <br />1240 E ONTARIO AVE A D-2-312 H D-2-312 <br />CORONA CA 82881 <br />~" ~- <br />SK <br />(,' <br />°~ <br />~3 <br />SK <br />[B15,SJj <br />lnEV.2-061 PRINTED 11-19-2007 <br />