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<br />CERTHOLDER COpy <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />N-?Dol-Ild- <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 N<:lOO$ -oQ3 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 10-01-2008 <br /> <br />GROUP: <br />POLICY NUMBER: 0720294-2008 <br />CERTIFICATE 10: 3 <br />CERTIFICATE EXPIRES: 10-01-2009 <br />10-01-2008/10-01-2009 <br /> <br />CITY OF SANTA ANA <br />ATTN: CITY CLERK <br />PO BOX 19B8 <br />SANTA ANA CA 92702-1988 <br /> <br />SP <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br /> <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <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 /> <br />CREPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1700 - MARTHA ARGUELLES - EXCLUOED. <br /> <br />ENDORSEMENT #1700 - PATRICIA FITZGERALD - EXCLUDEO. <br /> <br />ENDORSEMENT #1700 - SALLY M. LOW - EXCLUDED. <br /> <br />(")--"::: <br />,--{ <br />r,-' . <br /> <br />i' j <br />. <br />".) <br /> <br />r ...:.',~ <br />, , <br />"":J <br /> <br />I'.) <br /> <br />.' <br /> <br />-:? <br />l:J f <br />:>- l:,J <br /> <br />EMPLOYER <br /> <br />MARTHA ARGUELLES, AND SALLY M. LOW AND SP <br />PATRICIA FITZGERALD DBA: BRDZEY, LOW & <br />ARGUELLES <br />BOO W SANTA ANA BLVD STE 208 <br />SANTA ANA CA 92701 <br /> <br />M0408 <br /> <br />PRINTED <br /> <br />09-17-2008 <br /> <br />(REV.2-0S) <br />