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<br />, 12/16/2004 12: 07 FAX 3237829822 <br /> <br />REAlEST A TE. LOADED. FDS <br /> <br />Ii!! 002/002 <br /> <br />12/15/:æ04 <br /> <br />16,23 <br /> <br />STATE COMPENSATION -+ 913233751666 <br /> <br />NO. 133 <br /> <br />00Ø2 <br /> <br />CERTHOLDER COPY <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142.0807 <br />O»M~~N""TfON <br />INSURAN". <br />I=UN C CERTIFiCATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />rs8tll!: ».a.'fllh 12-15-2004 <br /> <br />GROUP' <br />POLIC'lNUMB£R: 12"301-~00. <br />CERTIFICATE 10: 120 <br />CER'I1FICATE EXPIRES: 0.-01-1005 <br />.. -01-200./0.. Dl.IOOJ <br /> <br />Thl. lalo ~ .,..... '-elo..... . V8IId ~ ComIJensoIIon '- policy In I fOrm 8PI>I'Öved by the CaIîrornia <br />InlulII- CÐmnn.ioll8r to Iha 8mpioy8r - botow ... till policy P8J1oc Indicet8if. <br />This OlIO\' II not oub ect 10 -Wan b I tile Fund 811C8p1 upon 3D dl)'8 -- wrfIIon notiCllO!hI omp/oyer. <br />We Wflllloo giVe you 30 ~"""OI /lOb ""- this po Ioy be -led prforlo.. 110II1I8I øpir8Øan. <br />ThI$ CtIIIIcII8 of ÍIIIUIW1Got " not... '"""""'" policy """ don IlOl_, eodend or ...... the ~ IIfDIWd b I the <br />poley IIs88d h8nIIn. ~d!nø 81'1' ~ III"" or condIUon or II1II' - or - docunìènt with <br />=.::. t~=-.ø"'V:= =:= ~~ :,~: thaM..".. -ed by the poIJcy <br /> <br />~ <br /> <br />-- <br /> <br />A.k...w.. t:. eL... <br /> <br />- <br /> <br />-I:.ImIa'. Io:UZUn IoDIn' IIICLD:1nIœ IJØIIIn CO8'l8: $1.000,000 'lit 0CCIIRIIIII'c:I. <br />II1I:I0118- uno - RDcIBR C InSg,_. - 1IXCLUmm. <br /> <br />, ~ '1100 . DOIJGLU R - ftIIiIS. - UCLlJl Jl . <br /> <br />IIIIDOIt8aa't UJOO - ftIIV II soana SIIC. - 1lECL0IIQ. <br /> <br />-II....., '20'5 III'f%TLIID C1IIInFXCAD IIOLDIIRS' IIO'Z'J:CII IU'nC!'fIft 04-01-2003 rs <br />UftCIIZD 1'0 AIIIII - A PU'r 01' ftZ. l'œ.:tcY. <br /> <br />.-emIR <br /> <br />APPROVED AS TO FORM <br /> <br />- /~~ - <br />-WIt ettt Jttlbtö., <br /> <br />SOIr1'IIUIID CØIIIIOIIZCA'1'%cm:s .. laTA Die 1»>., 8OU'1'BLII!ID <br />en -as <br />8370 ~ IItoVl> - 20' <br />uvzar.Y II:tIoloS all '02U <br /> <br />-- <br /> <br />-"'-""""'-'--"'--8I'ATI!_-- <br /> <br />~-- <br />