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<br />POLJCVHOLl}EH COP)'
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<br />STATE
<br />COMP'e:H~;,A,.'tON'
<br />IN G UFtA-.... <:;1'4:
<br />FUND
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<br />1>_0. OOX 420807. SAN FRANcrSCOXA94142,OBD7
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<br />CERTIFICAtE OF WORKeRS' COl\IIPE"NSATION INSURANCE
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<br />lSSUE OATS: . 't=2:,a~200s
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<br />GROUP:
<br />P'O-LICY ~ ,g()1-464-::l:(}(~5
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<br />CiRTl'FJCATE e;,;YPIRES:. tQ...c);t-2,~
<br />1Q-w,()1-20Q;S/ tQ-O,i-$ODS
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<br />.ctty 0.. SANTA ANA
<br />VINHNaf,JYEH
<br />~4 CIV1C CE~T~R ~LAZA
<br />SJU.rrhANA 'CA 92:70,2
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<br />'T'lhl.. is t-at;:t1dify thil:t'-yu h.;k'JC: t:.:rU" .~Q Vi"Q!kt.":ti:s: Cnrnp~~tfmlill"14'ut:;$l}:?t po.tl~{ tn a :fcnn ~rO">Jad bV t!':1O
<br />C#irOCJ"<IJ: l"'~Vr,;;n~ Comml$SiDof"1~r 10 1J.hff em.pr,pirer ffi'tffiJl!d: tmf{')w for thi'J p,:>l1c,:/ pi:!~fiQ-d indrcaMd
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<br />Thls p'obC'l ;'$ nOT ${W ~ecl to ,~r;.'l:'ei!;If1~Ci1 b', U'll!! Fupd ~xee;pt upgft 10 diYrs.~::v~ee 'JIflirt$:M rTUllCfr .0 It:e mnp'C>tf<h\
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<br />'.tih-: "'....~rj oittso Give you 1Q d.~s. M'?'.l~~ notic" $1101..4.:1 tM:;; pcJtcy he e#fl;,';(rlfen prior to' its l)br1'r~' vxpjr~o;"ii.
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<br />n63 cartili'l;',.,to o. b~:our;;if1<l8 i" not m.'l. i.~~C6 :D(,;di.(;>:r cgndd:,;." nOot an,'!iiftd.-O,ldeM '!:;,;"\' .;lHor ~l;:O;.\af~,.,i{l't,;.v;:Jt.""J
<br />by~hl(t pori..-;jI' lI!;l'ted h{lJc~in. N,:;mfi(iID'S<~~it';;!1 an~ r.equlr-O'me.u.tllilrm OF J;Qn':tiidon >of ;]flY <;or.1r.oc:t or orh~ dacumctrt
<br />Y'rifu !\~:l'~p~.tct~o 'j,,,,+'i~h this. c()t'un"',illt!i 0(. inSl.lr'anc;.~ ftl;;J'f bn i$;$ued Of' !to'. \-;..d~i't;h it may P~'1'taiJ''t Htrl,'!'. IHSlJIf.ance
<br />_O<IHonjljllrj by fhg pD'lf'Cl' de~rtl)""fj be<rein i~ wbfect 'rO ;;lHPUl' ~wms,. B;.::c.lu!'dal1s" rod <:'cNdtflon~.t:1t ~uoChpn-Jiey"
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<br />IMCl.UPING 01:I'EN$E (;OS,S, $' .000.000 PER OCCURRENCE_
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<br />E.NOORSEf<iEHT H t600 . dOHN THAI PREsIDENT SEC. - E:XCLlll>EO.
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<br />AD'VA,NCED ."RAASPOR1"ATluH CONCf:PTS tHe:.? tN: Sti
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<br />1 R,VtNre- CA 92802
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