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<br />07/24/2000 15:00
<br />
<br />90% 791329
<br />
<br />DIAMOND
<br />
<br />CERTHOLDER COPY
<br />
<br />STATE
<br />COMPIUol5.ATION
<br />rNSU,.AMCIii
<br />FUND
<br />
<br />PO BOX 420607, SAN FRANCISGO,GA 94142-0807
<br />
<br />ceRTlFICATS OF 1/IIORI<ERS' COMPENSATION INSURANCE
<br />
<br />rS1>UE; P.Il,TE: 0I!il-1,\I-200fi
<br />
<br />GROUP
<br />POl.lCY r-.,Ul\I1aER; 1a.a&flU-2006
<br />CEnTIFICA H: 10 1
<br />CERTlFICA Tt::t:)I.F"RE:;;'~ 0Iii-21t1-;lOO'JI
<br />06-~K-~00B/o&-2&-2007
<br />
<br />Cll'Y OF SAtfTA ANA
<br />PO BOX 1 t-81
<br />!tAN1A ANA CA '2702-1866
<br />
<br />SP
<br />
<br />Thi~ ,~ to eillrll;V \haj 'NoEl h)"6 It6!.11U:/ a vr.'ld iJlJork4rs' Cornper"l1;ltiO" lJ1s\Jr~nCl:l policy In , torm aopro"ed by tt\o
<br />C...lilmru. !nSl..r.aMlI Co,."ml~SJo",<,r Ie t~~ flmplOy9r n.m~d beto'^' for thE' policy ptH1odlnOlcateCl
<br />
<br />;hlS pGl;C\' is I"\or :subject to c.1(-:)II..~ipM }J\, (he f,J""d ellCI!:Pt upon 10 d..y.5 ..dlJ.ilnclIl wnttO:;{"l (loric.e 10 t~. e,.,plo'ief
<br />
<br />'J\;e """:11 QI~O ~Iv(l YO..: tOcl~y~ adv~rc" nml";" ~nould this pelleI' be c,nCIJI'ed prior to lt~ normill sxp,r.ll,o..,
<br />
<br />~"'I~ Cllrli1ic;r.~1l 01 LnJ~r''''Cl? ,,,not ir" Ln~lf"'H::e polocy .;lInd dolts not amend, e;o;tGnct or .tIter the cOII.rage ..!forded
<br />by tl'lG PO"C'I 11S~.1:S htlr.'r:, ~olWith"lSndlng oil'jr r.q...lfotmenl. lerm or CO'l<:l/('on 01 Iny co..,trilllCI or othli!lr documltnt
<br />with respeCI 10 vwhich thIs .:::o~tltn;_~e of ,"',st.J,';r.nc~ m...v pe ,s,ued or to which ,I 'lllly pen.ln, I~O I,..sur;r.r'lctl
<br />"Hordlld by lhe polic::y d~crlbld l'litH!ln I~ ,,"":;lj\'lct to ;r.ll the lI~rrn~" I3Yclu:!i'ons, 1I1"'d COr'ldlllol'l.s. o~ Sl..ctl POlicy
<br />
<br />6::RfP::::ZS ~
<br />
<br />~~lOYE.'S LIABILITY LIMIT INCLUDING OEFENSE COSTS: ~1.000,OOO PER OCCURRENCE.
<br />ENIJORSEIIIl!NT /lt600 - LUIS E"RtV!1II.A P,S l' - [XCLUDfD
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<br />LUI~ ~,R1VERA, . P . rNC
<br />222,2 So MIlXp,a ST
<br />S~A ~ C~ .2107
<br />
<br />SP
<br />
<br />'Rf~,.-.lS
<br />
<br />PIIIINTED
<br />
<br />[810.SP)
<br />015- 12 -2008
<br />
<br />PAGE 01
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<br />SP
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