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RTHOLDER COPY <br />SP <br />ATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION' p <br />IN5UF3ANCE N-oZfi(~.3 -o~7a <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~; _ ~G~ 3 _ ~ ~~~~~ <br />ISSUE DATE: 12-31-2004 GROUP: 000528 <br />- POLICY NUMBER: 0000318-2004 <br />CERTIFICATE-ID: 28 <br />- CERTIFICATE EXPIRES: 12-31-2005 <br />12-3t-2004/12-31-2005 <br />OFf1CE OF THE SANTA ANA LITY ATTORNEY JDe: <br />ATTN MS JUANITA HERNANDEZ <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <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 tc the employer named below for the pofcy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 3p days' advance written notice to the employer. <br />We will also give you 30 days'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, extender alter the coverage afforded <br />by the polices Ustetl harem. fVOtvvrthstanding any requirement, term, or condition of any contract or other document. <br />with respect to which this ceftificate of insurance may bessued or may pertain, the insurance afforded by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />,EMPLOYER'S 1IA5ILITY LIMIT INCLUDING DEFENSE COSTSa $7,000;000.00 PER OCCURRENCE. <br />`- ENDORSEMENTX2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE"12-31-2004 'IS ATTACHEDTO AND <br />'::FORMS A PART OF TNIS POLI#;Y. - <br />EMPLOYER <br />AIECOM DATA SYSTEMS, <br />1055 ELIZABETH DR' <br />RICHMOND KY 40475': <br />(REV.3-03) <br />LEGAL NAME <br />INC CYCON DATA SYSTEMS, INC <br />,. , oo~~mmor~. 11/17/2004 <br />