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Jul. 2, 2007 11,09AM HUB International of CA <br />No. 3845 P. 7 <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142^OeO7 <br />ca"PEN1V A6/�1AN C a <br />FUND CERTIFICATE OF WORKlRS' COMPENSATION INSURANCE <br />Ye9UG DATEt 12-81-2009 GROUR. 000678 <br />POLICY NUMBER. 0000616-2006 <br />CERTIPICAT6 Ibt is <br />CERTIFICATE EWIRCIR 12-81-2007 <br />12-01-2006/12-81-2007 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />BANTA ANA CA ef701 <br />SK <br />This Is to oartlfy that we have issued a valid Workers' Compensation inturance policy in a farm approved by the <br />California Laurance Commlasloner to the employer named below for the polloy perlad indlosted <br />i <br />This policy Is not cubjeot to cancellation by tho Fund except upon 10 days advance <br />written notice to the =player. <br />We will also glvs you 10doys advance notice should thla policy be cancelled prior to Its normal expiration <br />Thla certificate of Insurance Is not an Inaursnoe policy and doss not amend, extend or alter the oovoreee afforded <br />by tM Policy Ilated herein. Notwithatendf�tg any requirement term or condition of any contract or other document <br />wkh % fat to which thla oerilflcete of pnswmce may be Issued or to which h may pertain, the Insurance <br />atforded by Ne policy described herein Is subject to au the tarms, exclusions, and conditions, of such policy. <br />HORIZEO REPRESM�TAIIJOI PRESIDENT <br />INLEES INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UMBER THIS POLICY EXCLUDES TME POLL <br />'"061 NAMED IN THE POLICY DECLARATSONG AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND MSPS <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEPSMSR COSTSe t1,000,0o0 pan oCCURASNCG. <br />EtAPL0Y97 <br />PARSONS CHIS AND PARSONS, SSMEDETTA SK <br />8109 MAEeLE PL <br />RANCHO CUCAMOMRA DA 51700 <br />Bev.s•oB <br />PUNTED t 07-02=2D07 <br />Reesived Jul -0I-07 lolls Froe-661 760 2094 To-SAPD Pass OOT <br />SK <br />