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/ 12/18/2004 12:07 FAS 3237829822 REALESTATF.xLOADEDxFDS <br />12!15/2084 16:23 STRTE CONPENSgTION +' 913233751666 <br />CERTHOLDER COPY <br />STATE P•O. BOX 420807, SAN FRANCISCO, CA 94142.0807 <br />CCMPLNpATON <br />INLY aANGi <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />Issas nASS: 12-1s-aooe <br />eunaasDeermm~htiva <br />~ 002/002 <br />ND. 133 0002 <br />d <br />POL NUMBER: 1796]00-2004 <br />CERTIFICATE 07: 370 <br />CERTIFICATE EXFIREB: 01-OL-7004 <br />04-01-700{/04-01.2008 <br />/~R/R.rw.t~ G . ~, <br />ranaoa <br />88FLOYQ'S 7.211ffiLITY LIlQT ZdCLaD28P. D8PiII188 00858: ~i, 000, 000 P8R OOCaAABJtCa. <br />B~ORg~RT 01600 - R06ER C 8Igr03, PR68. - 8>[CI.9DYD. <br />ta8rOR8810aN5 /1600 - 1)OtYOiLlta R iO1rIIe SR8718. - 1~L•La08D. <br />tODOR681m15 A1i00 - 8'l8V8 tt SOaTER aBC, - S[CLaOfRD. <br />WIDOAg00BIR Aa06R Sl1T2TL8D CBRTIPICt\58 80LOSR6. 80TIC8 SllfC52VS O4-01-3003 I9 <br />ASTAC~D 50 A1® PO>Of9 A PART 07 5828 POLICY. <br />APPROVED AS TO P0~ <br /> ~. <br />~ <br />aw <br />a 9 <br />a <br />e <br />es <br />'--- <br />iNNDYOI (-~~ <br />~ <br />yb.a~d~y <br />y <br />} <br />y~ <br />y <br />14~tlldt>l~t W57 Attkflfl~r <br />7fOOTffia110 oolstoslCAT2oss aRASA arc >%71a soareLasn <br />Cax covsraRs <br />e]~o rrstassss SLVp BT8 aos <br />RsaERLY 8ILL8 Cif 90x11 <br />eV1~ MMN~aICON11 iN/lwwslYMwWmrMN11Nb'(7RICNLRATERP®DDpMRR' d elm <br />Thht K fo aAy tint ws htwa k<aued a xY1d Workers Ca~namlon IOSUr4ncs pONCy h a rpm approved by the Cafdomia <br />kisuranoe Canmreswrwr to ria amDlpYp' named blow for Ore Po1IOY lradod bldkBtW. <br />This pelloy b nOt subJact b canals0on by the Fund except upon 80 days wHana wAOen ratlce ro rie employer, <br />Wa vd8 alw give You 90 days advance no0p should rik po8oy ba mroelkW pdorb b normal expia8oa. <br />