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<br />Apr 07 08 10:3Sa Tll~-l <br />Apr 02 02 12:11p Able Rain Gutter_ <br />. <br /> <br />949 67-.....f-i4 <br /> <br />p.3 <br /> <br />POLICYHOLDER COFlY <br /> <br />STATE <br />COMpENSA.TION <br />lNSURAN:CE <br />I=UNO <br /> <br />POBOX 420807, SAN FRANCISCO,CA 94142.-0607 <br /> <br />CERTIFICATe OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 03-~1~2006 <br /> <br />GROUP: <br />POLICY NUMBER 1547M8-~OO8 <br />CERTIFICATe 10: 1ali <br />CERlIFICATE EXPiQES: O' -01-2*& <br />01-01-2008/01-01-2009 <br />T~lS CERTIFICATE SUPfRSEOlS. AND CORRECTS <br />CERTlFlCATE It 1B3 QATEO .o3~ 14-2008 <br />.oB: THE DiPOT AT SAHT A ANA <br /> <br />ClTV OF SANTA ANA <br />1000 ~ SANT A . ANA 8L VQ STf. 1QB <br />SANTA ANA CA 92701-3900 <br /> <br />SG <br /> <br />nis IS to cer~lfll tl1at we "ilve i:o;stJed .. valid VJorilters' COf"\POr'1sa~lon In-:;urencr:: pOliCY in ..form approved by 'he <br />(.allforni. :,.surs:'!CQ CO'illnissroner 10 the arT'lplo:.'er Il~rned bel::Jw ~O' ~h8 polie~ period incicll'led <br /> <br />Tt-is pollc'r is not sub;e=:l to cilncellatlon by Ihe Fund except upor 30 days ad\'.iI.,ce wrl1tel'1 I"lotiee to the &mploffr <br /> <br />''/\ie will all;.o giYEI you 30 days ad'Jilnce lO~.ce should \N~ POltCI' ~ C&1'Icel.ed pr or to iU normal (J.xpirOltion. <br /> <br />r"l, certif!cale of i1SU"~,.,ce ir. n01: <:;" hsurancll policr ,jid :ot::i not amend, Qxt&rld 01 0111101' tt\e cO\lerage 41ffo'd!Jd <br />by :he poh:;y listed. ~,~r'lIn, Not":"',lhst.rIdI1\9 arw requirement, term or condition o~ .ny conlrael or othfir dOCUmElfl[ <br />with respect to vvhlcl1 this; certlfrcate of InSUr.:lna6 may be Issued or to whicn II m~'1 ;:>ert_ir'l, the: ln$Urar-l~6 <br />iI'forded oy the PoliCY dl9scn",od herein is svblect to ai' the t8tms, exc(usiOris. ana conditions. QI such poiicy. <br /> <br /> <br /> <br />Q::RE??ESENTAm ~E~~ <br /> <br /> <br />UNLESS INDICATED OTH!RWlS! BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXC~UDES THE fDLUOWING; <br />THOSE NAMED IN THE POLICY DECLARAT10NS AS AN INDlVlDUAL eMP~Oye~ OR A HUsa~ AND WIFE EMPLOVER; <br />ENPLOVEES COVERED ON A COMPREHENSIVE PERS~L LIABILITV INSURANCE POLICV ALSO AFFORDING <br />CALIFORNIA WORKE~S( COIIIP'iNSATlON BENEFITS; EMPLOYEES EXl.':l_UDEC UNDER CALXFORNIA WlJRt<ER;S~ <br />COMPENSATIDN LAW, <br /> <br />E~PLoYeR'S LIABILITY ~lMtT INc~UD]Na DEFENSE COSTS: $1,000.000 PER OCCURRENCE. <br /> <br />ENDORSEMENT N2065 ENTITLED C'ATIFICATE ~D!RS' NOTICE EFFE~lIVE 01-01-2005 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLI~V, <br /> <br />'; ,~ >\)j,Ivl <br /> <br />~ <br /> <br />--------- <br /> <br />",( <br /> <br />\ ,iv '\11 <br /> <br />..:\ <br /> <br />EMPLOVEQ <br /> <br />ZOTDVICH, PETER RONALD DBA. PAT BUILOERS DBA: <br />ABLE RAINGUTTERS <br />3345 NEWpORT BLVD STE 214 <br />NEWPORT BEACH CA 92663 <br /> <br />ICAV.C~I <br />03-17-2008 <br /> <br />PRINTEO <br /> <br />IRf'/.2'C~1 <br /> <br />p.4 <br /> <br />SG <br />