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CERTHOLDER COPY <br />SP <br />P,O, BOX 8192, PLEASANTCN, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-14-2014 <br />THE CITY OF SANTA ANA <br />1000 E SANTA ANA BLVD STE 200 <br />SANTA ANA CA 92701-3900 <br />SP <br />R5 • <br />POLICY NUMBER: 9048536-2014 <br />CERTIFICATE ID: 4 <br />CERTIFICATE EXPIRES: 04-14-2015 <br />04-14-2014/04-14-2015 <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 30 days advance written notice to the employer. <br />We will also. give you 30 days advance notice should this policy be cancelledprior 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 conditlons, of such policy. <br />Authorized Representative - President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-14-2013 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY, - <br />EMPLOYER <br />ORANGE COUNTY CHILDREN'S THERAPEUTC ARTS <br />2215 N BROADWAY <br />SANTA ANA CA 92706 <br />(REV.1-2012) <br />SIP <br />LISA E. <br />Assistant GltY Attornev <br />M0403 <br />PRINTED : 03117-2014 <br />