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I O CER'{'II <br /> <br />ISSUE DATE: <br /> <br />,ERTHOLDER COPY <br /> <br />807, SAN FRANCISCO, CA, 94342-0807 <br /> <br /> COMPENSATION INSURANCE <br /> <br />'.GROUP: <br />.POLICY NUMBER:. . 064380822~O3 <br />)CERTIFICATE ID;,, .. <br /> CERTIFICATE E~,PI~ES? 07-O!-'2004 <br /> ~ ~ O7-O1~2~3/07-O1-2~4. <br /> <br /> SANTI ~ ': , ~ <br /> <br /> .' This is to Cerfif¢ ~t We hsve issued ~ ~lid ',Wd~k~' Co~ensat on ' n~r~e po~ cv n a ~¢m ..... ' ~ ~ <br />; '.: ' ~alif~rnia ~bra~ Commlssi0~br ~o the ~t&y~r n~md b~ro~ fo~,~6 policy perio~ indicate~ ~proged by2the <br /> <br />SC <br /> <br />'~'his~;poli i~'~not subject to' cancellation ,by*.t~e F~und ~cept Ul~on 30 days' ad~;a~ce written notiCb to ~ff'empl~ye{., : - ¢, <br /> <br /> . ~ - , . . , . - ;:% <br />.We, will, also giyeSyoq ~o ~ :a¢~ce.noti0~}sh~ld th s~ policy be cadc~lled pr or to ~ts n6r~expjr~t ~m <br /> <br />Th]~:ce¢~cate of insurance ~s nc. an i. suran~e pohcy~d does not a~n~ ex~n~ or, attar the coverage afforded - <br />bX ~he ~lre~es hstffd, heroi~. Nqtwlthsta~d~ng any. [equi~meh~, -te~m, Or c&n~io¢ q¢ any CB~t~t ~;~0~g,=~cu~ · , <br />With resp~ ~o whic:~ this certificate of insurance.~~ 'Ue~i~sued,or ~y~r~l~)the ns~a6de affdt~ ,~he ) ,~}'~ ~}}: ,'-,' <br />-policies~descHbe~ horo~n }s subject to a'! the terms.~e~tp~0n~ a~ condifion~ o?'~uch-polc es ;'~'. ? ' '~,:' '?"; ;=~ <br /> <br />~F~ECT~VE <br /> <br />MEXICAN A~ER] <br />( <br /> <br /> <br />