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Ma_y 08 07 06:39a Rodney Ward <br />714-639-8595 <br />p.3 <br />POLICYHOLDER COPY SP <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />IMUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE (DATE: 08-01-2006 GROUP: <br />POLICY NUMBER: 1643445-2006 <br />CERTIFICATE ID: 1 <br />£ _ CERTIFICATE EXPIRES: 08-01-2007 <br />08-01-2006/08-01-2007 <br />A <br />CITY OF SANTA ANA SP JOB:ALL OPERATIONS <br />' ?U:ZCHASING DIVISION ATTN: BILL O'CONNOR <br />FI, P. Q. BOX 1998 <br />.. SANTA ,ANA <br />CALIFORNIA 92702 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form, approved by :he <br />California Insurance Commissioner to the employer named below for the Policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the smlloyer. <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />With respect to which this certificate of insurance may be issued Or to which it may pertain. the insurance <br />afforded by the Policy described herein is subject to all the terms. exclusions, and ccjondiiions, of such policy <br />'`JTHORIZEO REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />HYDROBLAST <br />726 W ANGUS AVE STE G <br />^RANG= CA 92869 <br />SP <br />IRev.2-05) PRINTED : 07-18-2006 M0409 <br />