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Jun ' Z 07 1 North American Amusement P'1 <br />N- o?ooq -o66 <br />POLICYHOLDER COP" SO <br />STATE P.O. BOX 420807, SAN FRANCISCO.CA 94142 -1 <br />COMPENSATION <br />'A' *''9 AMC Is <br />``r D CERTIFICATE OF WORKERS` COMPENSATION INSURANCE <br />ISSUE DATE: 04 -27 -2007 <br />CITY IF SANTA ANA SO <br />CARLA TOMPKINS <br />=yIC CENTER PLZ <br />SANTA ANA CA 92701 -4058 <br />GROUP: <br />POLICY NJVIi 1848138 -2007 <br />CERTIFICATE ID: 21 <br />CERTIFICATE EXPIRES: 04-01 -2008 <br />04 -01- 2007/04 -01 -2008 <br />;ert'fv that we have issued a vaild Workers' Compensation insurance pe'iey in a to-m approved by the <br />" ^^ I^su•arce Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon3O days advance written notice to the employer. <br />VM , i' also dive y3u 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />-its certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage affordet <br />by the policy listed herein. Notw'thstandirig any requirement, term or condition of any contract or other docu'nent <br />.f.') respect to which 'his cer;ificate of Insdrance may be issued or to which it may pertain, the nsurance <br />... :.:-c_d by :he policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />14P.'HORIZED REPRESENTATIL PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 81,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - JOSEPH SLASH PRIES - EXCLUDED. <br />ENDORSEMENT #1600 - CHANTAL SLASH SEC,TRES - EXCLUDED. <br />�_- ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04 -01 -2006 Is <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />ENP: CYER <br />NORTH AMERICAN AMUSEMENTS, INC SD <br />?1101 CALABASH AVE <br />'ONTANA CA 92337 <br />[814,sq <br />4FEV.2.06) PRINTED : 04 -27 -2007 <br />