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CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94 1 42-0 80 7 <br />CERTIFICATE OP WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10-28-2011 GROUP: 000718 <br />_ POLICY NUMBER: 0000320-2010 <br />CERTIFICATE ID: 240 <br />- CERTIFICATE EXPIRES: 03-19-2012 <br />03-19-2011103-19-2072 <br />THE RELATED COMPANIES OF-CALIFORNIA SK JOB: SANTA ANA STATION DISTRICT <br />BOO N. LACY STREET <br />19201 VON KARMAN AVE STE 900. SANTA ANA <br />IRVINE CA 82612-1087 CA <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 !o the employer named below for the polloy period Indicated. <br />This policy Is net subject to cancalletlon by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should th(s policy be cancelled prior to Its normal explrat}on. <br />This oertlfice[e of Insurance Is not an insurance policy and does not amend, extend or alter the novefaga afforded <br />by the pOllcy listed herein. Notwithstanding any. requlrernant, term or condition of any oontraot or other document <br />with respect to which this certif loate of Insurance may be Issued or to which it may pertain, the Insuranoe <br />afforded by the policy described herein 1s subJect to all the terms,c/?afix?clu?s_lons, aOnd conditions, of such policy. <br />Authorized Repres antative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $7,000,000 PER OCCURRENCE. <br />ENDORSEMENT N20B5 ENTITLED CERTIFICATE HOLDERS NOTICE EPFECTIVE 03-19-2009 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PORTRAIT HOMES,INC <br />265 N JOY ST STE 200 <br />CORONA CA 92979 <br />APPROVED AS TO FORM <br />LISA E. STORGK <br />;Assistant Clty Attorney <br />SK <br />SK <br />[B1 E,SK] <br />taev,a-zo tol PRINTED : 10-28-2011