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POLICYHOLDER COPY <br />SP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE. 03-13-20f7 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />GROUP: <br />POLICY NUMBER: 0803748-2018 <br />CERTIFICATE 10: Isis <br />CERTIFICATE EXPIRES, 10-14-2017 <br />10-14-2018/10-14-2017 <br />This is to certify that we have issued a valid Workers' Compensation Insurance policy in a lorm 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 />afforded by the <br />policy <br />y described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT N2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PYRO SPECTACULARS, INC. SP <br />PO BOX 2320 <br />RIALTO CA 92377 <br />[P13,SDj <br />gv <br />{q CT. <br />(MV.7-2014) PRINTED : 03-13-2017 <br />