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<br />POL! CYHOL DER <br /> <br />y <br /> <br />SG <br /> <br />STATE <br /> <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />PD. BOX 420807. SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 07-01-2007 <br /> <br />GROUP: <br />POLICY NUMBER: 1854827-2007 <br />CERTIFICATE ID: 2 <br />CERTtF/CATE EXPIRES: 07-01-2008 <br />07-01-2007/07-01-2008 <br /> <br />CONTRACTORS STATE LICENSE BOARD <br />WORKERS COMPENSATION UNIT <br />PO BOX 26000 <br />SACRAMENTO CA 95B26-oo26 <br /> <br />SG <br /> <br />LIC PERMITH: 790965 <br />INCEPTION DATE:07-01-2007 <br />DO:SG <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 10 days Cldvance written notice to the employer, <br /> <br />We will also give you 10 days advance notice sllould this policy be cancelled prior to its normal expiration <br /> <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 herE/in is SUbject to all the terms, exclusions. and cOflditions. of such policy. <br /> <br />a::- REPRESENTAll - ~ <br /> <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT. COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br />EMPLOYEES COVERED DN A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br />CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />COMPENSATION LAW. <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1.000,000 PER OCCURRENCE. <br /> <br />yJj:8 <br /> <br />EMPLOYER <br /> <br />SCHAEFER. ROBERT D8A: R L S GENERAL CONTRACTOR <br />& MANT~C <br />18372 GOTHARD ST <br />HUNTINGTON BEACH CA 92648 <br /> <br />M0409 <br /> <br />IREV.2-051 <br /> <br />PRINTED <br /> <br />06-15-2007 <br /> <br />