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<br />CERTHOLDER COpy <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 12-18-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 1771109-2004 <br />CERTIFICATE 10: 3 <br />CERTIFICATE EXPIRES: 12-18-2005 <br />12-18-2004/12-18-2005 <br /> <br />SL JOB: <br /> <br />k' t7005-l~ <br />k - o-oo~ - {)~ 1" <br /> <br />CITY OF SANTA ANA <br /> <br />60 CIVIC CENTER PLAZA <br />SANTA ANA CA 92]03 <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />Califomia 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 10 days' advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not_an insurance pot icy and does not amend. extend or alter the coverage afforded <br />by the policies listed herein, Notwithstanding anyrequirem~nt, term, or condition of any contract or other document <br />with r.espect to which this certificate of insurancerT41ybei~sued or -may pertain, the insurance afforded by the <br />policies described herein is subject to all the terms, exclusiOns and conditions of such policies. <br /> <br />~ <br /> <br />J~ t!. <br /> <br />~ <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br /> <br />EMPLO'l'ER'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 DISCOVERY CT <br />MOORPARK CA 93021 <br /> <br />MASK SYSTEMS INC <br /> <br />lREV.3'03J <br /> <br />11/17/2004 <br /> <br /> <br />-. . <br /> <br /> <br />. . <br /> <br />", <br /> <br />. :' <br /> <br />SL <br /> <br />