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<br />ISSUE DATE:
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<br />: :t.~t:>':", ',' '.c;EATHåLOERCOPY
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<br />CER~~~,!~~~~~: ,~~eRS'.:C9MPENS"TI~.~'/INàURANCE
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<br />SANTA"'ÄtJ'A CA92101"}::';
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<br />GROUP:
<br />POliCY NUMBER: " , 14881143-2004
<br />CERTIF~i~\Q! ".14..
<br />CERTtFICATE>~IÆ&",,<!:2-9~ -2005
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<br />JOI;'A$IIÌST,ÞS ccNsûiit¡N¡;:.,:;,.'
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<br />This is to,C.rtl1y that we hive issued a valìd Workers' CornpenSltion insur...ce policy, in I form approved by the
<br />C.lifot~"'¡~.lnce Commissioner to the employer l\iIImed below for tt\&,'P~~ period indic8ted. ' .
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<br />This policy is not subject to c.,cella'tion by tne Fundr'exc8Pt. upon 30 c ¡¡ys' 8dv~e '~n04:~to the employet.
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<br />We will 1150 giV8.YOLl"39^<1ayS",~~. notice shouldthi,s p ) lcy be cancelled prior to:its,notm8t~~XPìratiOn.
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<br />This C8fti~icat8{.)f:Ji~~:,J$ P.åt~ ins~.nc. policy and does not .n;1e~, e~terJd or alter theøoveraQ~ afforded
<br />by the p~l¡çie$"~ hed~irt<-NqtwithsU!hdf/1g ,.any' re(juirement, term. or Ò-9n~itiQn Of .,V contr8Ctor;oth8l" document
<br />with res~ctto:.t¥VhiChthls"c.t'tifi~. ~f.t~.!itë'~Y'b, issued or ma)!, pë~tàini the ¡nsut.,ce8fforde~ bV the:' .
<br />Pá{icíes dtlscrìl:>8d herein is subject töáll;,"8~rTS;d.x~h;¡.!onS and condî~ions,ôt such policies. ' "
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<br />AUTHÒRIZ:!b.,~~~~e~èNTATIVe PRES IDeI'if. ". '
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<br />", EMPU)m'$ LIAB.i.U'V .IIIIT INCLUDINCiI DEFENSE COST5:$1.'OdQ'~~1'ooiEJt Occu,uENCE. .
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<br />"ENQØRSEMQ.aT'#208IS' ENTITLEO CERTIFICATE '~tRS"\NónCt EFFEè'rnE'oa";01"S&<)04 XSATFAQtED. TO AND
<br />'FOPMS A PART OF THI S ~OUCY¡ it ." ,.,,'\" ,'. ' " "0 ,', ' , "~~' ;,;, ",
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<br />,;,,, ,,' "'02'117/2004
<br />PRINTED: . ...J:.040~,
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