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<br />04/13/2007 14: 15 FAX 7148327793 <br /> <br />WAYNE/LOUISE <br /> <br />!4J002 <br /> <br />POLICYHOLDER COpy <br /> <br />.P <br /> <br />STATE <br />COl\A..ENSoP-TI0'" <br />,,,,SU"oP-NClil <br />FUND <br /> <br />P.o. BOX 420807, SAN FRANCISCO.CA 94142,-0807 <br /> <br />CERTlFICATE OP WORKERS' coMPENSA"ON INSlJRAN~ <br /> <br />Issue DATI: 03-2tl-2007 <br /> <br />~OUP: <br />POLlCY NUMBE:R: 182053'1-2007 <br />CERTIFICATE 10: 28 <br />ceRTIFICATE 5XPIRES: 03-D1-2008 <br />03_01-2007/03-01-2008 <br /> <br />SP <br /> <br />This is to certify that we haVe Issued . valid Worker.' CompensaQQI'l insur- policy In ; form i1ppr;lvIC tty the <br />CillifDt'ni. lnsL6ance Commlaioner to the 1/ttIloy8l' I18I'Md below for the policy petiod indic;tod. <br /> <br />This policy is I'Ot atJ:tjact to cancellation by the Fund .",cept upoI"I10 .days adv81'\C8 Vlll'ittsn notice t(l tht> aMployer. <br /> <br />w. will also give ytN. 10 da)oa ed\Iane. notlcs should this pQllcy b. aM'leelled priOl' to Its normal eX~lirlltion. <br /> <br />Thi5 certifl~ of inslnnCI Is not -' InIIUr;nce policy and dod not lIInend. e>ttd or at-.... the cov~rag" afforded <br />by the polic:y listed herein. Notwlthsbndina rnt I'Ilquir~ WM or concllion of ,.., contract or other ocx:ument <br />With rUflaCt to which this aertiflCiitil of Tnsui.- mAY b. Isll*i or to wtlklh It fM'f pertain. the insu-...ce <br />affordod by 1M policy described 1I....ln Is subjact to all the terma. exclUSions. anei conditiOns. of stiCh policy. <br /> <br />PR!SIOENT <br />ppLDlER'S LIABILITY ~nUT tNCLUDIMG DEFENSE COSTS: $1,000.000 PER OCCUJlRENCE <br /> <br />t~ <br /> <br />~ <br /> <br />- <br /> <br />,.,~;'n.(}IED AS TO FC--'\-! <br /> <br />eMP'",ovat <br /> <br />~/- <br />. .. "'." <' .: J" ,., ,. .'. <br />_ ....'...Ja ~~~,~.~.. 11-....-)' <br />/."",:"llt ~lty Ai'".;.,~1i <br /> <br />nuN!( TOG'THER . I~ ElBA: r ... I N Ie 1'QGImotER. <br />tHe <br />2100 E oaTH ST STE 200 <br />SANTA 1MA CA 92705 <br /> <br />[JGB.CSJ <br />PRINTED Q3-'2G-2007 <br /> <br />I1lE\I.2-MI <br /> <br />