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<br />08/ <br /> <br /> <br />ELECTRICAL <br /> <br />Dats:Br.!MD05 10:16AM Piilga:2of3 <br /> <br />liC <br /> <br />From: Oentse O@an At: In9Uranc@ Incorponltad FilXIO~ 9094882232 1'0: CfCSMOWn l!IeetrlQl & Oat_, I <br /> <br />CERTHOLDER COpy <br /> <br />STATE <br />COMPIl'NSATION <br />INSUlltANCS <br />FUND <br /> <br />P.O. BOX 420807. SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPiNSATlON INSURANCE <br /> <br />ISSUE DATE: 08-28-2006 <br /> <br />GAOUP: 00004. <br />POliCY NuiiBER: 0013345-2005 <br />CERTIFICATE 10, I'B <br />CERTIFICATE ~IRES: 08-03-2008 <br />01-02-2005/08-03-2006 <br /> <br />cny OF SANTA ANA. PUBI.IC WORI<S AGEIlCY <br />ATT: 111.-. llGOYEN <br />20 Clllle CENTER P1.AZA M-43 <br />SANT A ANA CA t27'0 <br /> <br />5e <br /> <br />This is 10 Cor1ify tNt: w. havl issued. v..id Workers' Compensation In$uranee pollc~ ." .. fClf'M IpprO\ll*fJ by the <br />c.l11ornla InturlnC'. Commillion... to tNt employer n.-ned b.h~w for tho policy p<<iod i0c5c.ted. <br /> <br />This POlicy 1$ not "-Ib,ttot to OIMelt"tiCIIn lI", the Fund ,Kelpr uPOnao d'~1 ad....,c. wrln,n nolic. to tho emplo)fer. <br /> <br />w. will "$0 Qrv. vou 30 days acWMlC'. nolie, .hat.lld this policy b. cancelled prtor to Its not'tnlf exptr..tim.. <br /> <br />nlis cortifie.. of ~surance Is not ., inlur<<tee policy and dou not ~ ,~lend or .Iter V.o cove..... .fforrMd <br />by the policy listed herein. NotwlthstNlnt anv requirement c.rm gr condition of """I comtiICt or other do<:\Iment <br />with rnp.ct to which this c<<tificat. of I'ntuf,noe rmrr be itlwd gr 'CO which it MAY ~n. tt.. i"surlnCe <br />.ffotdtld t.y the polley descrJbed ......in is subiect t:o air 1he 1etrN:. Bxc:lulions. Ind conditions. of sue" PCJlic)l. <br /> <br />~ <br /> <br />..d.~~. ~ <br /> <br />AUTHORIZED R6'RESENTATlVE PRESIDENT <br />~"LDnll'5 LIABII.ITY LUIT INCLUDING DEFENSE COSTS: $'.000,000 PEA OCCURRENCE, <br />ENDORSEMENT M'SOO - PETER uOSEPH FAZIO PRES,VP - EXCLUD~D. <br />ENDORSEMENT M'Soo - KENNETH GREG SAPERSTEIN SEC.TIlES - EXCLUDED. <br />- <br />ENDORSEMENT 12085 ENTITI.ED CERTIFICATE HOLDERS' NOTICe EFfECTIVE 05-03-2003 lS <br />ATTACHED TO AHJ FDRMS A PART OF THIS PDLICV, <br /> <br />Al'i'RUV J::.D AS TO [_', , <br />U"'h <br /> <br />~ <is- <br /> <br />Laura Slitt ShccJy <br />A".:>fstant City Allor:i::\ <br /> <br />EMPLOYER <br /> <br />CROSSTOWN ELECTRICAL l DATA. INC. <br />1413 DIAZ 5T <br />BALDWIN PARK CA 91706 <br /> <br />SC <br /> <br />~~,I'~' <br /> <br />(Bl0,SG) <br />PRINTED 08-29-2001 <br /> <br />~ UU3fUUC <br />