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CERTHOLDER COPY <br />Lu <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: D1 -27 -2012 <br />CITY OF SANTA ANA SC <br />PURCHASING DEPT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 82701 -4058 <br />GROUP: 000238 <br />POLICY NUMBER: 0013389 -2011 <br />CERTIFICATE ID: 14 <br />CERTIFICATE EXPIRES: 01 -011-2013 <br />01- 01- 2012/01 -01 -2013 <br />THIS CERTIFICATE SUPERSEDES AND CORRECTS <br />CERTIFICATE # 13 DATED 01 -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 policy period Indicated. <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br />We will also give you 10 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 <br />by the policy listed harem. Notwithstanding any requirement, term or condition of any contract or other document <br />With respect to which this certificate of Insurance may be issued or to which it may pertaln, the insurance <br />afforded by the policy described herein is subject to all the terms, excluslons, and conditions, of such policy. <br />tA.thorl..dRepresentative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1800 - ASESKHARAM, NADLEN CEO - EXCLUDED. <br />ENDORSEMENT #1800 - ABESKHARAM, NABIL PRESIDENT - EXCLUDED. <br />EMPLOYER <br />R B WELDING INC SC <br />185 E REDONDO BEACH BLVD <br />GARDENA CA 80248 <br />['R ii \lssi) rwi't0 FOkIM <br />til',f ,SI tlr <br />r.4uit City � i <br />IBIO,SCj <br />tREV.8-20101 PRINTED : 01 -27 -2012 <br />