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<br />SL <br /> <br />CERTHOLDER COpy <br /> <br />STATE po, BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />CITY OF SANTA ANA <br /> <br />60 CIVIC CENTER PLAZA <br />SANTA ANA CA 92703 <br /> <br />GROUP: <br />POLICY NUMBER: 1771109-2004 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 12-18-2005 <br />12-18-2004/12-18-2005 <br /> <br />SL JOB" <br /> <br />PI --- ';?VO?:>-lt;J4> <br />f\ - 0-001..(- ~1" 1" <br /> <br />ISSUE DATE, 12-18-2004 <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 10 days' advance written notice to the employer. <br /> <br />We will also give you to days' advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is notan insurance policy and does not amend; extend or alter the coverage afforded <br />by the policies listed herein, Notwithstani:Hng any requirement, term, or condition of any contract or other document <br />with r.espect to which this certificate of insurance may t),eissued OT may pertain. the insurance afforded by the <br />policies described herein is subject to all the terms. exdysions and conditions of such policies. <br /> <br />~ <br /> <br />~~c <br /> <br />~ <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br /> <br />\ <br />EMPLOYER 'SLIABILITY LIMIT INCLUDING DEFENSE COSTS; $1,000,000.00 PER OCCURRENCE. <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />MASK SYSTEMS INC <br />11959 OISCOVERY GT <br />MOORPARK CA 93021 <br /> <br />MASK SYSTEMS INC <br /> <br />.. <br /> <br />, <br /> <br />. :. <br /> <br />. . . <br /> <br /> <br />11/17/2004 <br /> <br />lREV.3-03J <br />