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CERTHOLDER COPY <br />1 <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08-19-2018 <br />MEGAN DOYLE LUDGATE <br />55 E JACKSON BLVD STE 1010 <br />CHICAGO IL e0604-4413 <br />GROUP: <br />POLICY NUMBER: 1110258-2017 <br />CERTIFICATE ID: 12 <br />CERTIFICATE EXPIRES: 12-01-2018 <br />12-01-2017/12-01-2018 <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 30days 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 />affordedbythepolicy described <br />herein is subject to all the terms, exclusions, and conditions, of such policy. <br />Authorized Representative President and CEO <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br />EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br />CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />COMPENSATION LAW. <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT H2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-1998 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />IKENBERRY, DENNIS AND IKENBERRY, JUDY DBA: <br />RACE CENTRAL <br />229 S OLIVE AVE <br />RIALTO CA 92376 <br />[JRC.CNI <br />(REV,]-2014) PRINTED : 06-19-2018 <br />SIP <br />