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CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10-01-2010 GROUP: <br />POLICY NUMBER: 0720294-20f0 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: f0-01-20f ? <br />t0-01-2010/f0-01-2011 <br />CITY OF SANTA ANA SP <br />ATTN. CITY CLERK p / ?`?Ov._ ?? "?Z <br />PO BOX 1988 / V ? U J <br />SANTA ANA CA 92702-1988 <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 f0 days advance written notice to the employer. <br />We will also give you ?0 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. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance 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 />thorized Representative Interim President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $x,000, 000 PER OCCURRENCE- <br />ENDORSEMENT #700 - MARTHA ARGUELLES - EXCLUDED. <br />ENDORSEMENT #700 - PATRICIA FITZGERALD - EXCLUDED. :? ?? <br /> ? :? <br />ENDORSEMENT #700 - SALLY M. LOW - EXCLUDED. <br /> ,;,. <br /> <br />.. N <br /> WJ <br /> C <br />?' <br /> - <br /> I <br /> ? ?? <br /> ?Z <br />EMPLOYER <br />MARTHA ARGUELLES, AND SALLY M. LOW AND <br />PATRICIA FITZGERALD DBA: BROZEY, LOW 8. <br />ARGUELLES <br />600 W SANTA ANA BLVD STE 208 <br />SANTA ANA CA 9270 <br />SP <br />SP <br />M0408 <br />IREV.1-2oio) PRINTED 09-77-2010