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<br />NO.4Q1 <br /> <br />[;I1j\::1~ <br /> <br />Q7/17/2~Q6 <br /> <br />17:05 <br /> <br />. <br /> <br />CEf'.THOLDER COpy <br /> <br />SP <br /> <br />STATE <br />COMPli1"lliAnON <br />Il'IiiURAHC:& <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO.CA 94 1 42,-OB07 <br /> <br />N .OtO~ _063 <br />/'I.~o o~ - oS}-o/ <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCi <br /> <br />ISSUE a~Te: O'~11-2001 <br /> <br />GROOP; <br />r'OUCy NUhII3ER: 07Z029~-Z005 <br />CliiRT1FICA re 10: ;3 <br />~!:RrIFlCAn; EXPIRES; 1Q-Ot-2006 <br />10~Ol-Z005/'O-Qt-ZOO5 <br /> <br />C1T~ Jf SANTA ANA <br />AT'IlI: CITY CLUK <br />PO BOX 1818 <br />SaNTA ANA CA '2102-1988 <br /> <br />SP <br /> <br />This IS to c~rtity tIlat we hWfI 'ISSUed a valtd Worlteirs' Com~ens.Jtio" insur~c" pOllCV in :J forrn lIpproved ~ t~C1 <br />California In5L6a1'\aa Commb5iOl'lflf to Vie emploVflr named blillow for the poliCY peflod inClcat"d <br /> <br />Thr. poJiey '$ "'Qt 5ubjll;t \'il' ~'Ml~eollltiQn 'Qy thl Fund eXCl~l)t UPQI1 to dlY;t WvillCtl wriuen notloe to the e.~loYflr. <br /> <br />We will al,=,o gi...e lOU 10 c!Gys adv.nce notic. $il'lOuld till:!.: peliOIl be cjll'celll!ld prior to its Mfmal Qxplr2tion. <br /> <br />Th~ OQrtl~'~ c: Im:urlif1ce is net 3I'l i"-SlJ"JnCO polley 2M does ,",ot amend, ~tI,",d ell' ~t.r tr.~ wQ\fli!fI9' afforded <br />by thQ policy listed herein. NotwitnStJndil"lQ IJf'IV r9Qulrllmillm. Ulfrn Or condition ot "'''1 ~ol"ltraet or o!~r do~ument <br />with r8tl1l8Gt to which thiS cli!ftifl'cote of jn'3\lflllce rmy bill Issued or t(J wI'Iietl it rn3l' pertain, ttl€l Insur3'lct; <br />iftgrdc<l by the ~oliG)' de!li:lrlhed hereIn Is subject to all the tarm" e:tcIU3ions. and condltJons. cf ,...ch .oDHCy. <br /> <br />d::R'~ <br /> <br />EM~LDYER'5 LIABILtTY LIMIT INCLUDING DI'INSE <br /> <br />~ <br /> <br />PRfSlOENT <br />COSTS: $110001000 PER OCCURRENCE. <br /> <br />ENllIlllSEMENT Nj~OO MM<TH/I. .RGIl'LL" - """,-UDOD. <br /> <br />ENDOIl$EN~NT ,'700 PATRICIA flTZGEIlALD - EXCLUD!D- <br />- <br />IiJIDOIlSEMENf #1100 SALLY 11II. LDW . EXCLUOiD. <br /> <br />- <br /> <br />~ <br /> <br />;\ PPROV ED AS TO FORM <br /> <br /> <br />'I <br />~ ~-~j <br />.r Sh!.;",dy <br /> <br />ilHli <br /> <br />,.',[ <br /> <br />^.", <br />.. '; '1', ~'V <br /> <br />rMPlO'fER <br /> <br />MARTHA. ARGUELI-ES. AND SAL.LY N. LOW AN) SP <br />PAT~lC1A FITZGE~LD PIA: BRDZEY, LOW & <br />AIlIiUELLES <br />t'OO v SANTA ANA 8LVD STE 201 <br />SAJ'ffA ANA CA '2701 <br /> <br />lJMS,CNI <br />PRI~eD ! 07-'7-2006 <br /> <br />ll1t:".z.cI~ <br /> <br />t J- ' <br />