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<br />02/27/2006 10,JO FAX J2J78201JO <br /> <br />FDS Southland <br /> <br />POLICYHOLDER COpy <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />PO. BOX 420807, SAN FRANCISCO,CA 94142.-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DAlE: 02-08-2006 <br /> <br />GROUP, <br />POLlCY NUMBER; 1286302-2005 <br />CERTIFICATE ID, 144 <br />CERTIFICATE EXPIRES, 04-01-2001'I <br />0.-01-2005/04-01-2008 <br /> <br />CITY or SANTA ROSA <br />ATTN; DONNA VENTURES <br />90 SA"TA ROSA AvE <br />SANTA ROSA CA 95402-1878 <br /> <br />SP <br /> <br />~OB:CONTRACT #8839 <br />ALL CALIFORNIA OPERATIONS <br /> <br />T'nl.. I~ to c&r~lly th.~ wo hive ;~Eu()d 31 v~l;d IJ\Jorkers' CC'rT'p.nsa~'on if1sur.once policV In .. form oiIpproved b't the <br />California !ns,ur.;Jnce CommissIoner to the employer named below for the policy period Indicated. <br /> <br />This policy i50 not subjecr to C8/lcelliltlOr'l by the Fund except upon30 days .ildvince written r'lotice to the employer. <br /> <br />We .......111 also give you aD days ad",ance nOllCS should this POIICV be cancelled prior to Its normal expiration. <br /> <br />This certlflcale of insur.nce IS no'[ ,3" lnsur.mce ~olley .and dOGS not OImend. extend or illter the covenge afforded <br />by the pOlicy h,ted "erem Notwltt'lstandlng an., reqUirement, term or conditio" 01 any contract or other document <br />with respect to which th(, certif,cate of In&ur,,cB t'T'I8V be Issued or to which It may perta,n. the Insurance <br />afforded by the policy des.cribed herein is SUbJect to all the tlm'T1$. 8)(ciusions, and conditIons, of such peller. <br /> <br />cr::::- REPRESENT A TI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEfENSE <br /> <br />~ <br /> <br /> <br />PRESIDENT <br />COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT "600 <br />ENDORSEMENT ,,600 <br />ENDORSEMENT '1600 <br /> <br />ROGER C FISKE,PRES. - EXCLUDED. <br />DOUGLAS R BOWEN TREAS. - EXCLUDED. <br />STEVE M SOUTER SEC. - EXCLUOEO. <br /> <br />ENDORSEMENT '20BS ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-0'-2003 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />~ <br /> <br />EMPLOYER <br /> <br />SOUTHLAND COMMUNICAYIONS & DATA lNC DBA: SP <br />SOUTHLAND CAR COUNTERS DBA: INfORMATION & <br />TRANSPORTATION TECHNOLOGY <br />8370 WILSHIRE BLVD STE 209 <br />BEVERLY HILLS CA 90211 <br /> <br />("EV, ~ .06) <br />1.- ._ _ __ ___.. _ <br />, <br /> <br />PRII'lITEO <br /> <br />(SLC,SP] <br />02-06-2006 <br /> <br /> <br />~002 <br /> <br />SP <br />