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CERTIFICATE OF WORKERS' COMPENSATION COVERAGE <br />ACORD DATEn,,M;DB'Yti <br />Ir. I~ ~x?uul~ <br /> THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />PRODUCER AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Allimll Ltsulan~c tins Iles Ins COVERAGE AFFORDED BY THE POLICIES BELOW <br />The Transamerica PYaamid <br />600 MuulgomerV~ Street, 9°i Floor INSURERS AFFORDING COVERAGE <br />San Francisco, CA 941 1 I <br />Phone. (411)403-1400 Fax:(4Uj402-0773 <br /> INSURERA Nunl'ro(its United 14'urkers Com znsation Grou <br />INSURED <br />INSURER B' SafCI'NallOnal IRSUfanCC'COID aI1Y <br />1nC. <br />Dnlllll$EIDn OD AICO1101 g DFUg A~USe <br />I ' <br />anlc L <br />IOrllla FI IS <br />I <br />, <br />. <br />I <br />p <br />U INSURERC <br />~ I1 r I Cuprtol Avonuz <br /> wsuRER ^ <br />Sucranrentu, l'4 95ti I n <br /> INSURER E. <br />COVERAGES Tnc CeOJ¢ale is nol mlentletl lu spenly all entlorsemenls. coverages, leans. contlieons antl exclusions of :ne pobc,es snpwa <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING <br />ANY REQUIRE MEN' TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THtS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E%CWSIONS AND CONDITIONS OF SUCH <br />POLICIES AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS <br />INSR TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LIMITS <br />LTR EFFECTIVE EXPIRATION <br /> GATE (MNJDDIYY) DATE IMMIDD11'YI <br /> GENERAL LIABILITY EACH OCCURRENCE 5 <br /> CDhIh1ERGIAL GENERAL LIABILITY' FIRE DAMAGE (Any one fuel F <br /> CLAIMS ldAOE OCCUR MED EXPENSE iAV O,a persml S <br /> PERSONAL 8 ADV INJURY 5 <br /> <br /> GENERAL AGGREGATE F <br /> <br /> GE N'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG R <br /> PRO- <br /> POLICV JECT tOC <br /> AD TOMORILf: LIABILITI COMBINED SINGLE LIMIT <br />(Ea acc,tlent) E <br /> ANV AUTO S <br /> ALL CWNED AUTOS BODILY INJURY' <br />P <br />r <br />erson) S <br /> <br />SCHEDULED AUTOS p <br />e <br />I 8 <br /> HIRED AUTOS BODILY INJURY <br />IPer aocitlent) 5 <br /> <br />NON~OSMED FUTOS S <br /> PROPERTY DAMAGE S <br /> ' (Per acatlen0 <br /> <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S <br /> ANT' AUTO OTHER THAN <br />AUTO ONLY EA ACC 5 <br /> AGG 5 <br /> E%CESS LIABILITY EACH OGGURRENC S <br /> OCCUF O_AIMS MADE AGGREGATE 5 <br /> b <br /> DED.IC TIdLE S <br /> RcTENT10N <br /> WORKERS'COMPENSATION AND WG STATU- ~' OTH- <br /> EMPLOYERS LIABILITY TORY LIMITS ER <br /> NPU-WCGOU-2007 111/07 111/118 Et-EACH ACCIDENT sj00,000 <br />A EL DISEASE-EA EMPLOYEE S?UO,000 <br /> E L DISEASE POLICY LIMIT g jOU,000 <br /> OTHER <br />R Gxcess ll'orAer's Cumpensalion SF-1 F81 CA 111107 L/I108 $2j, WO,000 x $500,000 WC <br /> $500,000 xs $SOQ000 EL <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIE%CLUSIONS ADDED DV ENDORSEMENT/SPECIAUPROVISIONS <br />Lvldence of \Nolkcrs' Compensation Coverage <br />CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES 8E CANCELLED BEFORE THE E%PIRATION <br /> DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL BO DAYS WRITEN NOTICE <br />NPULHCADA-OOd TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO <br />('I[y Ot Septa Ana OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />1FU' OTI:fOrCC I ^ ve5[mCni .AdmmlSlrallOB REPRESENTATIVES. <br /> <br />IOOO F. SaI1LIl AR8 BOUICPafd, SWLC ~20I) AUTHORIZED REPRES ATIVE <br />Santa Ana, CA 92701 ~~ T <br />ACORD 25S (7197) - v eA~.vni+ a.vnr ~rw, wn <br />TO •.CSO`J~UC,MA4ERSCCrt~! aie of Liabifry Iruwanee ACORD25-5 1 <br />