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714-685-1464 <br />Feb 0'A 2008 3:09PM A-�,;LooLo- )03 <br />CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 84142-0807 <br />COMPENSATION <br />INS UPtANCB <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 02-07-2008 GROUP: <br />POLICY NUMBER: 1877734-2008 <br />CERTIFICATE ID: 8 <br />CERTIFICATE EXPIRES: 01-01-2008 <br />01-01-2008/01-01-2008 <br />CITY OF SANTA ANA 50 JOB:ALL OPERATIONS <br />SHERRI BARCLAY <br />20 CIVIC CENTER PLZ M-36 <br />SANTA ANA CA 82701-4088 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This Policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an Insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate 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 />V <br />tTHIORIAZEDPRESENTATIA—�PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT #1000 - THOMAS, ROBERT PRESIDENT TREASURER - EXCLUDED. <br />EMPLOYER <br />R V THOMAS INC. DBA: WEST COAST LAND CLEARING <br />PO BOX 90126 <br />LANG BEACH CA 90909 <br />IB15,NCI <br />PRINTED : 02-07-2008 <br />IREV.1-051 <br />P.1 <br />SO <br />