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SC <br />• ERTHOLDER COPY <br />�E <br />P.O. BOX $07, SAN PRANCISCO,CA 94142-0807 <br />c <br />INSUWA NGE.` <br />— FU <br />1 CERtincATE or-, WORKERS' COMPENSATi6N, INSURANCE <br />ISSUE DATE: 07-011-2003 GROUP: <br />... -.. POLICY NUMBER;.. 0643908-2003. <br />CERTIFICATE ID; 69" <br />CERTIFICATE 6XptRES: 07-01-2004 <br />07- 4-2603107-01-2004 <br />R <br />SC <br />CQ G PRQ4RANk1Fik, „ <br />P.O. BOX �I9U . <br />SANTA AFiA. CA 92701 <br />Thrs is. to ceofy that we have issued a valid Workers' Compensation insurance policy in a form approved by'the <br />, <br />Gehfornia 11 f9brar ap Eommissioner to the employer named below for- the policy period. indicated. <br />This policy it not subjbct to cancellation",by the Fund,�akcept. upon 30 days' advance written notice to the employer. <br />We wi8. also give '.you 30 days' _advance nphcis should, this, policy be cancelled prior to .its normal`expiratign ,. <br />"This teili#1caEemof insurance is 0ot-an inswiande policy and does not amend, extend or alter the, coverage afforded <br />by the policies listed. herein. Notwithstanda1 0 afty requinement, <br />term, or cspndihon of any contract or other document <br />with res ct to which this" certificate of insurance" <br />"be ,issued' or r*Vertain, •the, insurance offord'oQby the <br />"policiestdiiscribedherein is s'ublect to all the terms, exclusions andconditionsofsuch policies. <br />Aj <br />AUTHORIZED REPRESENTATIVE PRESIDENTS " <br />EMP,LOyER'S LIA6IL`I7`Y 1..IMiT IMCLUDINO'DEFENSE COSTS: $1,000,060.,00 P.tR,`001110E4dE.7 <br />'g "' eMENT-.d'2069 ATITUM COTIFFIDATE tWAPS' NOTICE •EFFECTIVE"07-01.20p;� I3 ATT IED TO AND r <br />M.OART <br />,,. FUf+IAS OF '1'MIS.POL^ EC. " <br />Ail ROv ED Ella 10 '^ �_ IYL <br />)n <br />t< ^. ara SheedY <br />'I?eputy City Att tAcYr <br />EMPLOYER . <br />t ILMOWME <br />.7 <br />MEXICAN A�kAN�OPPOOUNITY fOUN. MEXICAN AMOIIAN.O�, Ttiuiy FatfNo", <br />'CLAUOIA GUTfOFf< ,'`RUFiNQ(A NDN-PROFIT COi1P.J <br />401'N OARFi-ELo AV.L'; <br />MONTEBELLO CA 90640, <br />MEv.a.oa) Q6- IA-2903....0nan9'.: <br />