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C'r= riTHOLDER COPV <br />sc <br />P.O. BOX 420807, SAN FRANC[SCO,CA 94742 -0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04 -19 -2017 <br />CITY DF SANTA ANA SC <br />PURCHASING DEPARTMENT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4058 <br />GROUP: 000238 <br />POLICY NUMBER: 001 3369 -2010 <br />CERTIFICATE ID: 6 <br />CERTIFICATE EXPIRES: 01 -01 -2012 <br />01 -01- 2011/07 -01 -2012 <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 pallcy period indicated. <br />This policy is no[ subject to cancellation by the Fund axc ept upon 10 days advance written notice to the employer. <br />We will also give you 10 days advance notice should this policy ba cancelled prior to its normal expiration. <br />This cartif icate of insurance is nol an insurance policy and does not emend, extend or alter the coverage afforded <br />by the policy listed herein. No[withs landing any requireman4 term or condition of any contract or other document <br />with respect to which this cectifieata of insurance may be issued or to which it may pertain, the insurance <br />afTOrded by [he 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: 51,000,000 PER OCCURRENCE. <br />ENDORSEMENT N1600 - ABESKIiARAM, MADLEN CFO - EXCLUDED. <br />ENDORSEMENT H1600 - ABESKHARAM, NABIL PRESIDENT - EXCLUDED. <br />EMPLOYER <br />R B WELDING INC SC <br />155 E REDONDO BEACH BLVD <br />GARDENA CA 90248 <br />[BtO,SC] <br />tnE V.s -2oto> PRINTED 04 -19 -2011 <br />