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CERTHOLDER COPY <br />SP <br />�A QOhAPil�t$AT1pN P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />INS 4RANCi <br />FUND CERTIFICATE OF WORKEW COMPIE:MSATION INSURANCE <br />ISSUE DATE: 08-18.2009 GROUP: <br />POLICY .NU 1701033-2008 <br />CERTIFICATE Ilk 5 <br />CERTIFICATE EXPIRES:07-01-2010 <br />07-01-2008/07-01-2010 <br />CITY OF SANTA ANA SP <br />COMKMUITY OMLOPMENT Ai1ENCY <br />PO BOX 1888 <br />SAWA ANA CA 92702-1988 <br />This is to certify that We have issued a valid Workers' Compensation insurar►ca policy in a form approved by the <br />California Insurance CoarnlsSioner to do employer named below for the policy period indicated <br />This policy is not subject to Cancellation by the Fund except upon 30 dW9 advance written notice to the employer. <br />We will also give you 30 drys advance notice Should to policy be Cancelled prior to its normal expiration, <br />Thfe, eertif;e*e Of insurance is not an insurance policy and does not ary"d, extend or after the Coverage afforded <br />the Policy listed herein. Not ' <br />w�ltlr respect to which this cerUf rt�orre� 'to— or condition of any contract or other document <br />Issued or to which it may pertain, the insurance <br />afforded fry the policy described herein is subjectmay be to all the terns, exclusions, and conditions, of such policy. <br />ZZED R MSENTA PRESIDENT <br />EMPLOYERVS LIABILITY LIMIT INC=tNG DEFENSE COSTS. $1,000.000 PER OCGIIRRENQE. <br />ENDORSOWff 0200 ENTITLED CERTIFICATE HOLDERS' NOTICE ERFECTSVE 07-01-2003 :S <br />ATTACHED TO AND FORTIS A PART OF THIS POLICY. <br />EMPLOYER <br />THE VILLA CENTER INC SP <br />910 "J"C t ST <br />SANTA ANA CA 22701 <br />(811;NEI <br />iasv.T-oai PRINTED : 08-18-2008 <br />bd Wd0V:T0 600E BT -6nd 6bET2-bSPT2-: 'ON Xtia aE]1N30U-nIfl3H1: WOaa <br />