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O1/J1/2007 15:54 FAX J2J7b20130 FDS Southland <br />POLICYHOLDER COPY <br />STATE PO BOX 420807, SAN FRANCISCO,CA 94142,-0807 <br />INSUIanNCe <br />F V N © CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-22-2007 GROUP <br />POLICY NUMBER: 1880288-2008 <br />CERTIFICATE ID; B <br />CERTIFICATE EXPIRES: 04-07-z007 <br />04-01-2006/04-01-2007 <br />CITY OF SANTA ANA PUBLIC WORKS AOENCT SC JOB: ALL CALIFORNIA OPERATIONS <br />ANN: SHAHIR GOBRAN <br />20 CIVIC CENTER PLZ N-43 <br />SANTA ANA CA 82701-4058 <br />Thlt.lb to earn}y that we have Issued a valid Workers' Oempeneahon insurance pokey In a form approved by the <br />Califmnla Insurance Lolnmissioner to [he employer named below for the policy period Indicated <br />OOJ <br />Sc <br />~ - p2o05-1iy <br />A - aaas- iiti - o I <br />This policy lb no[ sub]sc[ to cancelNUOn by the Fund sxcep[ upon f0 days advance written notice to the employer. <br />We well alw give you f0 tlays adwnce nonce should this policy be uncalled prior Io its normal sxpvauon. <br />Tnn car bf icate of lmurance is not en insurance policy end does not amend. extend or aher the coverage afforded <br />by the policy listed herein. Notwlthstantling any requirement, term or Condition o} "any contract or other tlocumem <br />with respect Io which this ear tiiiu[e of insurance may ba issued or m whleh It may Dertaln, eke ineurance <br />alfortlsd by the policy desaibsd herein is subject to all the terms. exclw~ons, rid conditions, of such policy. <br />THORIZED REPRESENTAT' PRESIDENT <br />EMPLOYER'S LIABILZTT LIMIT INCLUDING DEFENSE COSTS: 21,000,000 PER OCCURRENCE. <br />ENDORSEMENT N1800 -ABRAHAM TA3HMAN PRES. - EXCLUDED. <br />ENDORSEMENT N1800 -MICHAEL BLITZ CFO SEC. -EXCLUDED. <br />°~. ,"'•~'~:v/ ASS TC FORYi <br />EMPlOYEq <br />FIELD DATA SERVICES CORPORATION <br />8370 WILSHIRE BLVD STE 208 <br />BEVERLY HILLS CA 80211 <br />a[sv.rasr <br />'- .,...,Cij~ <br />A~•..~ta.ll Lity i~t(or;cy <br />SC <br />IESI,SP] <br />PRINTED 01-22-2007 <br />