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<br />, , <br /> <br />,-,'", <br /> <br />~L' <br /> <br />;ERTHOLDi:R 'Copy <br /> <br />STATE po SOX8Q7o. SAN FRANCISCO.CA Q41,42-Q8Q7 <br />cO""P!!I'IS~'l:ION <br />II'ISUFtAl'lcr;; <br />F= U ND CERTIFICATE, OF \1VORKI;f\S' COIYIPENSA TION ,INSURANCE <br /> <br />ISSUE DATE, 02 -01-2005 <br /> <br />THE COMM REOEV AGENCY OF THE C I TV OF <br />SANTA ANA MUS I NG {. tiE I GHBOR,WOO OEVE L <br />PO BOX 1988M-26 ' " ' <br />SANTA ANA CA 92701 <br /> <br />GROUP, <br />POLICY NUMBER, 14~435$-2005 <br />Ci:RTIFICATE 10:, 2$2 <br />CERTIFICATE EXPIRES, 02-01-2005 <br />02-01-2005/02-01-2005 <br /> <br />JOB: <br /> <br />This is to certify that we have issue'd a valid:'\i\/orkers' Compensation,insur"a9c:e policy in'a form approved by the <br />California Insurance Commissioner to the employer "nam~d below for the p.9Jicyperiod jndica~ed. <br /> <br />This policy is not subject to cancellation by thE':' Fund except upon.,30days,' advance writtE!n notice., ,to the employer. <br /> <br />We will also give you 30 oayS' aoyanfe notice shoulO this policy be can,elleo prior t9 its n6rmal eXPiration", <br /> <br />This certificate of insurance, is no,! an insur~nce policy ano ooes not am~no, extehoOral.ter the c9verageafforoeo <br />by the policies Ilst~o herein: N9lwlthstanOing; any requirement, term, 9r Canclition of any cOntiact or otherOacument <br />with respect to,which this certif.kate-o,f,insi,.lrance'~~Y ,bS:i,ssued or may 'peft4in"ths in,suraoce afford,e9',',by the , <br />policies described herein is subject to aU t~e terms, excll.1~jbl1s ami conditions oOf~uchp,olicles. <br /> <br />~ <br /> <br />J~c <br /> <br />&L <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br /> <br />, ,', " <br />ENDORSEMENT #2065 ENTIn ED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-01-2005 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY, <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1.000,000.00 PER OCCURRENCE. <br /> <br />.fEG~LNAME <br /> <br /> <br /> <br />APPROVED AS TO FOL , <br /> <br />EMPLOYER <br /> <br />RINCON CONSULTANTS, INC <br />790 ~ SANTA CLARA sr STE 103 <br />VENTURA CA 930QJ <br /> <br />RINCON CONS~LTANTS. <br /> <br />~EV.J-031 <br /> <br />