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<br />CERTHOLDER COPY <br /> <br />SG <br /> <br />STATE <br />COMPENSATION <br />INSURANCIi <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142.-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: OSw09-200B <br /> <br />GROUP: 000229 <br />POLICY NUMBER: oo2307B-2006 <br />CERTIFICATE ID: 94 <br />CERTIFICATE EXPIRES: 01-01-2007 <br />01-01-2006/01-01-2007 <br /> <br />THE DEPOT AT SANTA ANA <br />1000 E SANTA ANA BLVD STE 108 <br />SANTA ANA CA 92701-3900 <br /> <br />sa <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />C.ilifornia Insurance Commissioner tathe employer namedbelovv for the policy period indlcated. <br /> <br />This policy is flot subject to cancellation by the Fund except upon30 days advance written notice to the employer, <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate 01 insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstandin!il any rl9quirement:. term or condition of any contract or other document <br />with respect to which this Cllrlificahll of Insurance. may be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is SUbject to all the terms, exclusions, and conditions, of such policy. <br /> <br />~REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1.000.000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EffECTIVE 01-0t-2005 IS <br />ATTACHED TO AND fORMS A PART OF THIS POLICY, <br /> <br />- <br /> <br />EMPLOVER <br /> <br />GAFF GROUP, INC AND/OR TRI-COUNTY DRYWALL & <br />INTERIORS INC. DBA: GAFF GROUP, INC DBA: <br />TRI-COUNTY DRYWALL & INTERIORS, INC. <br />1592 N BATAVIA ST STe 2 <br />ORANGE CA 92867 <br /> <br />fflry <br /> <br />PRINTED <br /> <br />leKS,eN! <br />05-09 -2006 <br /> <br />(REV.2-051 <br />