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CERTHOLDER COPY <br />P,O, BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 05 -25 -2012 <br />CONTRACTORS STATE LICENSE BOARD <br />WORKERS COMPENSATION UNIT <br />P.O. BOX 26000 <br />SACRAMENTO CA. 95826 <br />GROUP: 000541 <br />POLICY NUMBER: 0504549 -2012 <br />CERTIFICATE ID: 7 <br />CERTIFICATE EXPIRES: 05 -24 -2013 <br />05 -24- 2012/05 -24 -2013 <br />SP LICENSE NUMBER:LICENSE #743267 <br />INCEPTION DATE:05 -24 -2012 <br />Dii <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 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 />Authorized Representative <br />President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 111600 - SHAFFER, JOHN, PRESIDENT - EXCLUDED. <br />ENDORSEMENT 111600 - ZEKO, MARK, VICE PRESIDENT SECRETARY - EXCLUDED. <br />r; n <br />EMPLOYER <br />ENVIRONMENTAL ENGINEERING & <br />INC. DBA: EEC <br />501 PARKCENTER DRIVE <br />SANTA ANA CA 92705 <br />AND CONTRACTING, <br />[B1Z,SP] <br />(PEV,a -2010) PRINTED : 06 -05 -2012 <br />- Zo //- 102- 0�,. <br />SP <br />