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04/20/2007 12:00 <br />CERTHOLDER COPY <br />STATE <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142.--0807 <br />COMPENSATION <br />INSURANCE <br />FUND <br />CERTIFICATE OF WORKERS' COMPENSATION lNSURA m <br />ISWE DATE: 04 -20 -2007 GROUP: 000228 <br />POLICY NUMBER: 0035508 -2006 <br />CERTIFICATE Ili 20 <br />CERTIFICATE EXPIRES: 08-01-200?.* <br />0E -01- 2008108 -01 -2007 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />SAWA ANA CA 82701 -405& <br />This is tO certify that we- have issued a valid Workers' Compensation insurance policy in a form approved:bv the <br />California Insurance Commissioner to the employer named below for the policy period indicated <br />This policy is not subject to omceI 4ion by the Fund except upon30 days advance written notice to the employer. <br />We win also give you 30days - advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance Wnot an insurance policy and does not amend extend or alter the coverage afforded <br />by the policy listed herein Notwithstartding 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 />0:= ftEPRPSENTA PRFSIDENT <br />9NPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 110M - JEFF L ROVINSKT P,S T - EXCLUDED. <br />ENDORSEMENT 02065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04- 20-2007 IS <br />- — ATTACHED TO AND FORKS A PART OF THIS POLICY. <br />EMPLOYER <br />I <br />JEFFREY LEONARD ROViNSKy MA: EXTERIOR <br />{ PRDDUc'TS INC <br />`j 25782 PRAIRESTONE DR <br />LAMM HILLS CA 92853 <br />IMEV.2 -051 <br />SG <br />(JMS,CN) <br />PRINTED : 04 -20 -2907 <br />NU. bbb 1,w2 <br />3G <br />