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CERTHOLDER COPY <br />STATE P.O. BOX 420867, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INgUFtANC! <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP:. <br />ISSUE DATE: 10-Ot-2007 N' aC~i J~S3 ~ POLICY NUMBER: 07 2 9281-2 007 <br />CERTIFICATE ID: <br />-~,pOG _ V~3-v / CERTIFICA70-O1P20Q7/tO-Ot-2006 <br />CITY OF SANTA Al/A <br />AlTM' CITY CLERK <br />po aox un <br />SANTA AMA G 92702-1afa <br />N-2007-19 2 SP <br />Tn:s :x to cart:fy tMt we nave issued a valid Workers'' dobelow afor the DO11t:Y por[od [nd[ca~etl approved by the <br />Cal~}Ornu Inx~rant:e COTmlxxlanef t0 the Bmp OVO <br />Tnis pOIKY [x not sublet[ t0 GnttliaLOn by the Fund except upon 10 days advance written notice to the emDlDYer. <br />We wdl also give You 10 days adwnee notice should this paLCy be cancelled prior to its normal exp+rafion <br />Ths eerUhcate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />w:tn~esopect tie wn[enr ns cert[fiaate~of n sunnee ma9 ba issuotl or tandwhkfi R may pertaxttne insurance ument <br />afforded by the Dollcy deseribetl herein is sub)ect to all the terms, exclusions, and eontlitions, of such pokey. <br />V ~~ ~- <br />L~ PRESIDENT <br />THORIZED REPRESENTAT! ER OCCURRENCE. <br />EMPLOYER'S LIA6ILITY LIMIT INCLUDING DEFENSE COSTS: f1,000.000 P <br />ENDORSEMENT e1700 -MARTHA ARGUELLES - EXCLUDED. <br />ENDORSEMENT At700 - PATRICIA fITZGERALD - EXCLUDEO- <br />ENDORSEMENT /t700 -SALLY N. LOW - EXCLUDED. <br /> <br />T~~ <br />rn-G <br />T rn <br />r~ <br />~ N <br /> V <br /> <br />2~ <br />~ <br />Z <br />t-D N <br />.8s <br />EMPLOYER <br />NARTfiA ARGUELLES, ANO SALLY M. LOW AND SP <br />PATRICIA FITZGERALO OBA: BR02EY, LOW 8 <br />ARGIIELLES <br />~A A~p~ANA7B01YD STE 208 <br />PRINTED 08-17-2007 <br />SP <br />MW08 <br />IREY.1-OSI <br />