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<br />STATE
<br />COM'PENSAT,ION
<br />INSU~RAN CE"
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<br />. P.O. BUX420807, SAN FRA~C1SCO: QA 941~2-0!l07'
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<br />. ThispoliQy is not subject t.Q ea~f'ellatioh. byt~e ~und,~xcept,upbn t'l(l!'l~ys~aclvansewrilten~ahee tqthe employ"r::]' .,~, " ,,:i,.:~;;<:;,,'.;Zj~
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<br />VV" 'will,also give youTiJlI:day~ adv~n~ notiee's~()uldtl)i~ po\icybe::ea~.eeU,,(H"iortbit.s,n<:i!mal expiration.": -:'i\ "'," ..-.' y,:> ',::;:.::>
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<br />CERTIFICATE OF WORKERS' COMPENSj\TIOr-AINSURANCE
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<br />. '. POLICY NUMBER;
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<br />"CERTIFICATE EXPIRES:
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<br />'_"i~lg4i::U;'.
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<br />.i;.1!
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<br />JANUARY
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<br />12"
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<br />2007
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