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<br />01/24/1994 16:28 <br /> <br />714-432-1735 <br /> <br />LUDLOW & ASSOCIATES <br /> <br />PAGE <br /> <br />01 <br /> <br />JUN. 27. 2001 10:35AM <br /> <br />NO 5965 <br /> <br />p, 4 3 <br /> <br />CE"'TIFICATE HOLDER copy <br /> <br />trrATE <br />..........'f',... <br />IN.".AHC- <br />"UND <br /> <br />P.O.ll0X420S0T, SAN FRANCISCO. CA94142.080r <br /> <br />C~RTIFICATE OF WOftKiRS' COMPENSAllON IN8UAANCE <br /> <br />JUIII 27. 2001 <br /> <br />GROUP: <br />POUCYNUMllEA: 1!.1191-:M. <br />CIiRTIJICATE ID: 11 <br />~1'1~ICATEEX1"IRE5: Ol-Ol-,OI> <br />01.DI-ZOalIOl-01-JO,3 <br /> <br />.. CITY or SANTI>. >>1J; <br />fllIl,I C IIORKi AG8!lOY. 1'AA"I C glOlIlIBlU1IC <br />*0 C~VIC CEIITIl' 'LUA. H.U <br />~ ~ CA 92701 <br /> <br />'IIllt 10 \0 certif~ II'1II we he>le ...... ..lld worko(. CD~1OI1 i_1lOkY in a 19"" 'I'I'"'''''d b,lhe C,WD"'''' <br />,_ eam",lIslonlf 10 the ''''ployo' nome<! belOW to. ... poI\el' peMcllridcated. <br /> <br />TNe DOlley il not lubjllCllO canr;ollatkm by "'''uncl excopt upet\ 30 d. ocIv_ _n IlOllce 10 ll1e om~loyer. <br /> <br />W. Wm ...., give you .Q dlys advtnce notice should tIliIlX"lcy be concelled priOr to ita nennol """ration. <br /> <br />1lU <*IIIlolIIO of inourlrlCII io not I. i"U","CO pOlicy Ind dMI nlII.....nd. eJdoInd or II1lIt tile """"1\1' aff<>rW4 by 'ho <br />1ICl10l1I IlIlad h'''''. NotwiU,s,.nlllng Iny requI,eminI, llMm Of ccndltlcn of .ny ~Qt1 or OIhOf clo<:Umonl oM\h <br />~ \0 wtUctl 11118 celUlCll' of inlUl'II'CI mlY bl iIIuad<< rtIW'/ porbli'\, 1he IIIIU"roOG ~flo",od 'oY tna poOeie$ <br />a.ecrtll-' llertln .. "'*0110 all tho lan'lll, al<Ciilalont. Ind coodlllcM, (il1uc:h pOIleiao. <br /> <br />~ <br /> <br /> <br />J{~ -<~~-.~ <br /> <br />_I <br /> <br />MJTMOIIUIID "'AUlNtAtf\ll <br /> <br />JMtWYBI\' S !.1A11lloU'Y LIIUT lNcLtlDtNG DiVENS I COSTS; $1,000.000 PER O<:CURRS~<:B <br /> <br />IMCORiBMENT .20&5 JNtITLSg elRrlrIe~TI RoLDIRS' VOTICS ZFFlctIV! 03-01-,CC1 15 <br />loftJ.CIIllt> TO NIP roRM8 r.. PAllT or TKIS POLICY. <br /> <br />'i'ICI~ JNDQRSZHENT 12015 ~TTr..eKID. <br /> <br />~ <br /> <br />~. ZIMM&~ ENgINEIRING I~C. <br />1500 '~Cli'Ie ~T WWY <br />S~ iS~ C/>. 907.0 <br /> <br />1CW'1Htf <br /> <br />APPROVED AS TO FORM <br /> <br />rYf~~ <br /> <br />Laura Sheedy <br />DepulY City Attorney , <br /> <br />IEOF-Ul; 1M) <br />