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<br />"'" <br />POLICYHOLDER COpy <br /> <br />STATE POBOX 420807. SAN FRANCISCO, CA 94142-0607 <br /> <br />'-' <br /> <br />c:O.....EN....Tl0N <br />lroCsVAANCC <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />MAY 9. 2003 <br /> <br />GROUP: <br />POLICY NUM!l1:P.: 1<51115 -2003 <br />CERTIFICATE 10: 3 <br />CERTIFICATE exFIRES: 04-0).-2004 <br />0<-01-2003/0<-01-200< <br /> <br />CITY 0" SANT1I 1INA <br />2 0 C IV! C CENTER l?t.A.ZA <br />SlINT!'. ANA 0. 92702 <br /> <br />This IS to certify that we have issued a valid Worke(s Compensation in&urance policy in a form approved by lhe Cel~on". <br />Insurance Commissioner \0 1M emplOyer named below for the policy peI1Qd IndI""Wd. <br /> <br />ThIS poncy is not subject to cancella1lon by lJ\e Fund ox""pt upon 10 day. advance wrllleo nolice to the employer <br /> <br />We win also give you 10 doy. .d""nce nolicu should this policy be cancelled prlor to,i1s normal expitabOn. <br /> <br />ThiS certificate ofinsurance is nct an insurance policy and does not amend, eJdend or alier lJ\e eoverag. sffot<lo<l by the <br />policies fisted herein. Notwithstanding any requirement. tenn or condition Of any contract Of other document with <br />"",p<lct ~ which Uiis cartiflcaIB of insurance may be issued or may pertaIn. the insurance affocded by Uie policies <br />described herein is subject to alllhe terms, exclusions, end ccndlflon.. of such policies. <br /> <br />~ <br /> <br />.&~ C. ~ <br /> <br />"'\1rrla~IZ:50 REPFtCS;N"ATrvt. <br /> <br />"""'0"'" <br /> <br />EMPLOYER'S LcAEILITY LIMIT INCLUDING DEFENSE C05~S, $1.000,000 PER OCCURRENCE <br /> <br />i\PI'RO\TIJ \S TO FORM <br /> <br />- <br />Lura S!Jcl.'dy <br />Deputy CIty ^tl[lrT1\~~' <br /> <br />E,",~ER <br /> <br />Duncan Parking Tec~nolog;~s. Inc. <br />340 Industrial Park Road <br />Harrison. ~ 72601 <br />