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CERTIFICATE HOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142 -0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />JANUARY 6, 2003 GROUP: <br />POLICY NUMBER: 428297 -2002 <br />CERTIFICATE ID: 38 <br />..CERTIFICATE EXPIRES: 09 -24 -2003 <br />- 09 -24- 2002/09 -24 -2003 <br />CITY OF SANTA 'ANA <br />ATTN NABIL SABA <br />P 0 BOX 1988 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />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 30 days advance written notice to the employer. <br />We will also give you 30 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 by the <br />policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br />described herein is subject to all the terms, exclusions, and conditions, of such policies. <br />er <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09 -24 -2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />AI'PROV1,✓D AS t'O i ORNI <br />La ra .hL°cdy <br />Deputy City Atlorncy <br />EMPLOYER <br />BEAVENS SYSTEMS, INC. <br />2200 PACIFIC COAST HWY <br />HERMOSA BEACH CA 90254 <br />SCIF 10265 rEPF -UI: JT 1 <br />