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Apr 01 10 09:13a OCCTAC <br />• <br />ISSUE DATE: 04-14-2010 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ M25 <br />SANTA ANA CA 92701-4058 <br />SP <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 />(M -?-6) <br />p.2 <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 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, exxc'lluusllonns, and conditions, of such policy. <br />tthon,'ed Representalive Z Interim President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-14-2005 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />X .S SO Too <br />P•4YR?V?D <br />?-9y P co nay <br />mststa / <br />EMPLOYER <br />ORANQE COUNTY CHILDREN'S THERAPEUTC ARTS <br />2218 N BROADWAY <br />SANTA ANA CA 92708 <br />7145649690 <br />POLICYHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP: 000687 <br />POLICY NUMBER: 00007722009 <br />CERTIFICATE ID: 18 <br />CERTIFICATE EXPIRES: 04-14-2011 <br />04-14-2010/04-14-2011 <br />SP <br />SP <br />M0409 <br />REV.120101 PRINTED : 03-17-2010