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<br />~ <br /> <br />Sep 06 07 11:54a <br /> <br />Public Works <br /> <br />7146473345 <br /> <br />POLICYHOLDER COpy <br /> <br />STATE <br />COMF'I'!NSATION <br />INSURANCE <br />FUND <br /> <br />P.o. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 09-05-2007 <br /> <br />GROUP: <br />POLICY NUMBER: 1875328-2007 <br />CERTIFICATE 10: 11 <br />CERTIFICATE EXPIRES: 01-01-2008 <br />01-01-2007/01-01-2008 <br /> <br />A ;/}D01-/~L/ <br /> <br />CITY OF SANTA ANA <br />BLDG INSPECTION DEPT <br />20 CIVIC C!NTER PLl <br />SANTA ANA CA 92701-4058 <br /> <br />sa <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the pOlicy period indicated. <br /> <br />ThiS policy is not sUbject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this poilcy be cahcelled pI i<;" to Its normal expiration. <br /> <br />This c"rtificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded <br />by the policy listed herein. Notw;thsunding 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 conditions. of such policy. <br /> <br />Q::-REPRESENTA~ <br />EMPLOYER'S LIABILITY LIMIT <br /> <br />~(~~- <br /> <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000.000 PER OCCURRENCE. <br /> <br />ENDORSEMENT 11600 - DONALD RHOD!S PR!SIDENT - EXCLUDED. <br /> <br />ENDORSEMENT N1BOO - JULIE RHODES V.P. - EXCLUDED. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />I WATER INC. <br />11 MARCONI STE A <br />IRVINE CA 92618 <br /> <br />L$i. ." "Le/<:j0/ <br />SG /'",/ / <br />/ <br /> <br />(flI:V.< OS\ <br /> <br />[KPX,CN] <br />PRINT~D 09-05-2007 <br /> <br />p.3 <br /> <br />SG <br /> <br />