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<br />AUG. 24. 2006 9: 17AN <br /> <br />self (~~jJ~bb-~~( <br /> <br />CERTHOLDER cpPy <br /> <br />, <br /> <br />Sl( <br /> <br /> <br />P.O. BOX 420807, SAN !"RANCISCO,C.ll. 94 142.-oe07 <br /> <br />CERTlf:ICATE OF WORKERS' COMP&NSATIQN INSURANCE <br />GROUP: <br />PCWcy f'lJMBEft: 0II45a81 -20oil <br />~TIFICAT~ IP: 21 <br />CmTIFICAT! EXPIR!S: 07-0' "2007 <br />07-01-zaoa/07-01-Z007 <br /> <br />SAN ~ AHA PQ~IC~ DEPA~TMENT <br />DJV nOM N-n <br />80 lVIC C!NTlA P1.Z <br />sAN A ANA CA 12701-4080 <br /> <br />SIC <br /> <br />"his to certify tIllt w. twll II548d .~ ~lllct Warkers' Com~.na~on lnlU('Il'1Clt p::Ilic:v In I form IpprOlllq Py tM <br />C.Pf rnla Inauri/l"l Ccmmluil:N1lr to Inl ernpiay. nllmea belaw fer the pgllcv p.riod (NliclltllCi <br /> <br />T)\II oUc;y I, Ilot sllbJ..t ~ cane.Unlon bV tMe I'und I:II:Cept upCll'l30 davs Idv..,c. wrIttan l"C1tiC' to the lMTfliOf.r. <br /> <br />w. <br /> <br />ill also 1iI1~1 VllU 30 ciIIYI IQII.f\CII "ot~. aho&lld thi. "allov b. cenc.lI.d prior to lta (101'",,1 IUlpirllllOl'l. <br /> <br />.. <br /> <br /> <br />"\lrr~18 of iNllflncl III not 111 insurll'll:l pg lIev Ifill "lNS not Jln\1nd. .>>etal'd ar lIt. l1'M CCllllr.g' .tfarad <br />policy li1t1d Mrllll. Notwl'ltl$andlnQ lffl r.q\.llr-m1lC'l1. terM' or cOI"d(tlon Q' I/W eontr.aot or ~.r dO~l'1ent <br />upaa 10 v.t\lch this c'rllfi~. of r/l~-nc. may P' I..ued Clr 10 whlCl'I .It m-y p~r ,,,. in_IO~' <br />d b., tn, policy ptsc:ri~lIQ l1.ein [, IWIlJIGt to III the tllm\L .xc:lUllons, lI'Ia cClnditlonL ot Sl.lcI'I pOlicy. <br />I~'~~ ~ <br /> <br />YI:Il'S LIAlJlI.ITY l.IM'IT INCLUDING DEII!NS! CQSTS: $l,OOC,OOO PER OCCURRENCE. <br />EJlIENT noes ENTIT&.eP ce:IlTII'lCATI! ~'-PI"S' NeTZCIE EFFICT1\11 OT-O~-1'BI IS <br />J] TO ANIJ fORM! Ii PART Of THIS POI-JCV. <br /> <br />\. <br /> <br />- <br /> <br />E;M>L.OYeA <br /> <br /> <br />5T tNT!R~TtONAL. <br />nQNON AVE <br />~ a. CA 1lI1i0l <br /> <br /> <br />SIC <br /> <br />lJIl!\/.=.oCIl/ <br /> <br />"'UNT!:D <br /> <br />~G1 r~~1 <br />al-z4-"iQaet <br /> <br />, /?~-t' <br />r/'~e17 <br />