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<br />'P:~.BOX'807, SAN FRANCISCO,CA 94142::--0a07
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<br />.:~.,lS~OA)E: 10-01-2003
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<br />GROUP:
<br />POLICY NUMBER: 1302849-2003
<br />i;;ERTIFICATE 10: 29
<br />CERTIFI!';ATEEXPIRES: 10-01 -2004
<br />10-01 c2003/10-01 "'004
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<br />$.AtlT A ANA POL t C):: . tl~N.Rt"'''NT SO
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<br />SANTA ANA CA 92702-69~6
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<br />~;~--t~_ cer~--that we have tSS~.!I:f-a_Valid--Wcirker$' Com~ensation insurance POliCY",ii,. -~orm,,-~~rGved bY,':',itt:t.{,."
<br />J~:j{ffornia tri'sUranee Commissioner to tba/ ~er named below for the policy pedod indi~d. - ><- "- - '
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<br />This pdli~-_ii$:--~-_-:$iJbjt,~t, to",'~antellation by the Fund e~eept u~on 30 da~: ,dvance written notice to the employer.
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<br />."",,,..,,,:,ijt also give yo~ sO dllys' advan<:e. n'!'lice .iiouid.thls policy be cancelied prior to Its llo';';'F'''i''Pir~';n.
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<br />l'hIlt'~rtniCJte'9.t'ln.U(.""" ~~ ~ insurance policy and dollS not amell<j, eKiend or alter the coverage afforded
<br />br,ths pol,i6i">~*~ b~~i'1>4~ithstandi.ng anyr4tquir_,~~"term. or ccnditio~ qf IN;ly.~'9fl~aet or o~er:.doqum~.~",,,,,;::
<br />wIth re.l\8Ct.:o whIch If>.. c"'tillcate of Insurance l'/'UW .!>e.,ssued or may. pertaIn. the'Sl"illIri!'lCs .ff<<~ by the '.'
<br />pol~Fj8S 'd~er'b.d henJtI1 IS subject to ~n, tn, terl'l'l$.\~e1~sIQns and condltl,ons of'~\pdJjcltls.', f~~~';'" " ;:"":',
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<br />,~' M:FENSE r.oSTs: . $ i, 000',000.00 PER dr.o.lR1i....cE.
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<br />TrFICATE HOLDERS' NdtrclrI$Ffl.<<CTIVE 10-01-2003 IS ATTACHED TO AND
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