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. ~,- <br />PpLICYHOLOI:R COPY <br />STATE P.O. SbX 420$07, SAN FRANCISCD,CA 94942--0807 <br />COMF~SNSA7tON <br />lNSUFtANCE <br />Q CERTIFICATE OF WORKERS' COMPENSATION iNSURANGE <br />ISSUE DATE: 10-04-2008 GROUP: <br />POLICY NUMBER: 9714034-2008 <br />CERT(P[CATE 1D: 83 <br />CERTIFICATE EXPIRES: tp-04-2009 <br />90-Oa-2008/10-04-2D08 <br />~ CITY ^F SAFt9'A ANA 5P c1OB:MA#~ItfOLE SPRAYING FOR RbAC}1 CDNTRDL <br />20 CIVIC CENTER PLZ RM a29 <br />SANTA ANA CA 92701-4058 <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 indica#ed. <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br />V11e will also give You tp days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance !s not an insurance policy and does not amend, extend ar alter the coverage afforded <br />by the policy fisted herein. Natwithstandiny any requirement, term or condition of any contract or other document <br />with respect t4 which this certl#lcate of insurance may be issued or to which it may pertain, the insurance <br />a##orded by the policy described herein is subject io all the terms, exclusions, and conditions, of such policy. <br />Ck~'~ r~t~ <br />HQRIZED REPRESENTATI PRESIDENT <br />EfAPLOYER'5 LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. <br />~~a~~~~ ~- ~ ~~ <br />~~ `~~.~s~eedy ~y <br />~~~ ~ ~t~1 Y ~~totfl <br />~SSlS`ant <br />EMPLOYER <br />GDLDEN BELL PRODUCTS, ING <br />t2p0 N JEFFERSON ST ST#: M <br />ANAHEIM CA 82807 <br />SP <br />SP <br />MlJ4 t0 <br />(sev.2-o51 PRINTED : 03-t7-2008 <br />