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CERTHOLDER COPY <br />P.O. BOX 42?yQ0APfS F 1 S??,CA 94142-0807 <br />CERTIFICATE 14ik'WDRKERS"7COMP,5 VSATION INSURANCE <br />ISSUE DATE: 04-01-2011 CL F G60UP: 000290 <br />POLICY NUMBER: 0002003-2011 <br />CERTIFICATE ID: 69 <br />CERTIFICATE EXPIRES: 04-01-2012 <br />04-01-2011/04-01-2012 <br />CITY OF SANTA ANA <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br />SG JOB:ALL CALIFORNIA OPERATIONS <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 30 days advance written notice to the employer. <br />We will also give you 30 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 herein. 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 pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />°"'r" L <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - WHITECOTTON, ROBERT P,S T - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />,kPPRO V f;1) AS TO F(A e <br />i-aura Stitt She Y <br />^,;?istant. Cite Attclrn <br />EMPLOYER <br />MASTER LANDSCAPE 8 MAINTENANCE, INC. <br />10171 NORTHAMPTON AVE <br />WESTMINSTER CA 92683 <br />A-oZ0 ``-oaka <br />SG <br />[ES 1, SG] <br />SG <br />PRINTED : 04-01-2011 <br />(REV.8-2010)