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t -IOLDER COPY _ <br />-STATE P.O: BOX'$07, SAN <br />60MPEIV5A'J'IpN FRANCISCO;CA 94142 08Q7 <br />. <br />N 5,U RAN'GB _ <br />FUND CERTIFICATE OF WORKERS` COMPENSATION INSURANCE <br />ISSUE DATE 08; ,t5-2005 - GROUPS • 000488 ' <br />POLIOY NUMBER:`• + j1000678-005 s <br />CERTIFICATE <br />CERT[PjCATE)CPIf3ES OB t5,,200G <br />`3. --= t 08;-15-2005/08`t 200E`"' <br />CITY OE 5ANTq ANA:COh3tjt)t{�Y <br />R O w iQ�B sd:r t t w k <br />"SA <br />t+TV A1dA; CAA 92702'18 r, <br /><r ' This is to cert+i, that wd;have Issued 3 vahtI, VVs}rkeGsr Cotnpeh akton hnsurapoe' policy in" aF adgrov by +�ti <br />5 Caltfargia `f risurance Commissienet to the employer ,named tIerov far the pgtrcy period <br />:This pohcy.+3 not subjeFB�to ganc,eAaugn By.;he Fuhd e5ccept upon 30days AA'dvanc VvFllt:@n hotice,/`ta the AmIziOYef -h„ r { <br />x We WIEIso a v <br />adYarpcd°e}tt!c�e 5hould,Ifg5 p'914oy:;,6e, caReelled p81pr_'to r sr opmaE. Xpira toH: <br />:,,This Fertif'fcale of Itisur'al,%66 ig'p$t an tnsutance PCilicy 6Via drpe5 'n'bY amenTl; .e'ktend bt'aF o the covgrage a�ftsfded <br />by the-policI s lisjed. herein}N��t vithstandtng apjI r'e )uiI gent term;„or'condltion of afire-traef, o2: otiAe doauntept <br />wuh,rq.�pect to which thts cettitrcate o4 mSruance may,O.& issued or may per'Eaiit,.the jnkelr�nce. af4orde 6y t e,.. <br />poll cies,descrlbed herein is sult7e'ct to a@ the; terms, exeWsiohs ah$�'Zcbadrtions of sych` pir' ' ' 4 - <br />AUTHORIZED REPRESENTATIVE , <br />PRESIQENf, <br />EMPLOYER'S LIABILITY LIMIT: INCLIID,IN� DEFENgF=,COSTS-',$1,000,000 0& PER TOCt;URRENCE - s <br />ENDORSEMENT N20t33 ENTI7CED CERTIFS C,4TE HOLDE'(tS' tdOTICEEFFtCTIVE 08-t5=200.�'�:ATTAC^kiEt)=.TO <br />FDRMS.-A PART OE' TFi,}S <br />C `- - - - � '- B ♦ v;-R t L' it v. <br />E4p, VE-21. A TQ RKiVk 1 -` <br />1 <br />jt, <br />•_ ., - r H alot�iiL L1i,�.+.�ttOYA2.}4�� .�<gJy_�4 <br />EMPLOYER} <br />, <br />t. <br />WISEPLACE,.A CA CORD WISEPLACE, A CA co -; <br />1411 N BROADWAY <br />SANTA ANA CA'92706 <br />is <br />IREV.3-03)-07/18/20.05'- <br />,PRINTED: <br />