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C'�HTHOLDER COPY <br />sC <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04 -19 -2011 GROUP: 000236 <br />POLfCY NUMBER: 0013369 -2070 <br />CERTIFICATE ID: 6 <br />CERTIFICATE E %PIKES: 01 -07 -2012 <br />01 -01- 2011/01 -01 -2012 <br />CITY OF SANTA ANA SC <br />PURCHASSNG DEPARTMENT <br />20 CIVIC CENTER PLZ <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 Lha policy parlod indicated. <br />This policy is not subject [o cancellation by lha Fund except upon 10 days advance written notice to [ha employer. <br />We will also give you 10 days advance notice should [his policy be cancelled prior io its normal expiration. <br />This certificate of insurance is nol an insurance po {icy and does not emend, extend or alter the coverage of forded <br />by the policy listed herein. Notwithstanding any requirement, farm or condition of any contract or other document <br />wish respect to which this cectificate 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 />' - "...� L <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - ABESKHARAM, MADLEN CFO - EXCLUDED. <br />ENDORSEMENT #1600 - ABESKHARAM, NABIL PRESIDENT - EXCLUDED. <br />EMPLOYER APPROVEIU AS TO FU12..tv1 <br />R B WELDING INC SC ra St:[i S y <br />155 E REDONDO REACH BLVD Assi�tani. City Attorney <br />GARDENA CA 90248 <br />[B 1 O, SC] <br />triev.a -�otol PRINTED 04 -79 -2011 <br />