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<br />07/'8/2335 lS:47 <br /> <br />3103702474 <br /> <br />HYGIENE TECH <br /> <br />PAGE 03 <br /> <br />Slil <br /> <br />'OLlCYHOlOER COpy <br /> <br />STATE PO sox 807, SAN FRANCISCO,CA 941.112-0807 <br />CO,....PEWSATIO'N <br />I NSU RANCE; <br />FUN [) CERTIFICATI: dFlIIIORKf.RS' CbMPENsATI~'N"INSURANCE <br /> <br />ISSUE DATE: 01-01-2005 <br /> <br />GROUP: <br />POLICY NUMBER' 1539354-2005 <br />CERT.F1CA 'E 10: 107 <br />CERTIFICATE EXPIRES: 01-01-20<>6 <br />01-01'c 2005/111 "01-2006 <br /> <br />, <br />C!TY Of SANTA- ANA <br />RISK MANAGEMENT, <br />POBoX 1938 M~28 <br />SANTA AN,. LA 92702 <br /> <br />SG <br /> <br />JOB: <br /> <br />This !,S 'to c(ltt'ity thlt we h.:lvEi Issued a valid Workers' Comper'lsation insl:'ranC8 pOliey in liII form; approved bY: t"e <br />Californl~lnsur"l1ce- ComrrdS,slonerto the ll,mp1over n.amecf b.low 10rtl18 polICY period indicated. <br /> <br />ThiS policy 'is not. subject tocanceU.at.on t1y the t;:'und e")(c~pt upon 30 da'1s,' .dv.,ce Vl,jtitt~nn4tlC8 to. tk8 em.p'-oyer~ <br /> <br />We wit! '8lso gi\ie YOIJ.~b'days".Jdv~c:r- notice snould [hIS policy be canciPlI4id prior to .itsnoi'triaf"stt'P'ltiJtion, <br /> <br />C':, "':,, ',',",,' <br />This6ertlh'cate crihsLl~BNl::e, i9 dof ~r1 insur...ce poliCY ~d dOIf's n01 wnend;, 8XIIf~d::'or ..1'tert/led~verag8 ~1fordelJ <br />bv the'pohcllts)js,~ed h~i~:'No.~ltl'l<standi,r' an~'r~qt!ir~,I'T'l_e~t. term. orcon.tlltIO~:' 01_, anv C'an~r..~t or-ot"er: documetlt <br />wlthresp~c~"t6 I(\th.lch tht!; clR'tlflca\e ohln-suranCCi' tfl~_,bS'--'1'3sued or may pert~It'(tt1e InsUra"~8 aftordedby the <br />polICIes df!scl'il::lel::l nereln IS subject to all t~e" te~m!i. .xcliJ~idnS and conditions','o'f sueh' policies. <br /> <br />~ <br /> <br />.A~ f!. <br /> <br />~ <br /> <br />AUTHORIZED REPRESENT A TIVE <br /> <br />PRESIDENT <br /> <br />[""LOYER"S"LIABILfTY ~rl4tT INCLUDINll "EFOrSE COSTS" S1.Q()Q;o<io,'OO PE",bcc:;u~Il[~E, <br /> <br />ENDllIlSEMENT '''~085 ENTITLE!> CERTIFICllH HOLDERS' NllTi<<;E EFFECTIVE'01.-0'-~oO.,5 'IS ATTllQiEll TO NID <br />FORM~ A PAIlT Of THIS POLiCY. ' <br /> <br />v't'ROV~L> AS 1'0 FORM <br /> <br />~7 ~ <br /> <br />. ,:1..i(I~tI'tt Shce <br />;-;(,'i1~. City At"r1ey <br /> <br />EMPLOYER <br /> <br />LElilAL NAME <br /> <br />HYG I ENE TECHNOI..OG' ES ,I NTERN,AT I aNAL <br />INC. I <br />3625 DEL AM BLV,D sn ..180 <br />TORRANCE c,. 90503 <br /> <br />HYIOJtNE TEcHNaLOGI~S INTEIlHATIONllL, Jm" <br /> <br />(RE\I_3-0J) <br /> <br />PRINTED: <br /> <br />\2(17/200.4 <br />:ii.1 k <br /> <br />P0410 <br /> <br />.:IL....J.J...II'jl::l"..:r..............:f..12:.r.".f::t::I~I:::t."::""":"":1.1"~1. <br /> <br />-;, ~ 'U~. I . <br />