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I I . .ERTHOLDER SK COpy STATE po. sox 807. SAN FRANCISCO,CA 94142-0807 COMPENSATION INS URA NeE FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-2004 GROUP: POLICY NUMBER: 0409B27 -2004 CERTIFICATE ID: 19 CERTIFICATE EXPIRES: 01-01-2005 01-01-2004/01-01-2005 C!TY OF SANTA ANA ATTN CITY ATTORNEY PO BOX 1988 SANTA ANA CA 92702-1988 SK JOSEPH W FLETCHER This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give YOl.! 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the poHcies listed herein. Notwithstanding any requirement. term, or col1dition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ~ ~~c &L- AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER DCCURRENCE. ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2004 IS ATTACHED TD AND FORMS A PART OF THIS PDLICY. ~~ ;::,\:,,:, EMPLOYER LEGAL NAME KINKLE, ROOIG~R, AND SPRIGGS 3333 14TH ST # ~OO RIVERSIDE CA 92501 KINKLE, RODIGER, AND SPRIGGS (A PROF. CORP.) f1M }-