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FROM : GOLDEN HELL FAX NO <br />171463WM7 Jun. 16 2008 12:31PM P2 <br />POLICYHOLDER COP* SP <br />STATE P O. BOX 420807, SAN FRANCISCO.CA 94142-0807 <br />CQIAPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKMW COMPENSATION INSURANCE <br />ISSUE DATE: 10-04-2007 GROUP: <br />POLICY NUMBER: 47i4034-2007 <br />CERTIFICATE ID: as <br />CERTIFIC 10-04-2007,110-0A-2008 <br />CITY OF SANTA AMA <br />20 CIVIC CEMTER PLZ RM 422 <br />SmTA AM CA 92701-40" <br />so ". KAN qLE SPRAYING FOR ROAM COMM <br />This is to certify thsl we have issued a valid Workers' Compansation insurance Policy in a form approved by the <br />California vuwance Coromns+oner to the employer named below for the policy period indicated <br />This policy K not subject to Cancellation by the Fund except upon 10 OWS advance written notice to the ernOlOyer <br />We will also gwe you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br />This CerlifiCatt of Insurance is not an insurance policy and does not amend extend or altar the coverage afforded <br />by the policy lifted heraim. Notw0standina any requirement, term or condition of any Contract or other document <br />with re$Mct to which this CertifiCste Of insurance May be issued or t0 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 />ITHORIZEo REPRESENTATI PRESIDENT <br />ZWLOYEU'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 11.000,000 PER OCCURRENCE' <br />ENIPLOYER <br />GOLDEN BELL PRODUCTS. INC <br />1200 N JEFFERSON ST STE M <br />ANAHEIM CA 92307 <br />SP <br />00410 <br />tREY.2•05j `T PAINTED : 09-11-20O7 <br />