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CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 02-11-2009 GROUP: <br />POLICY NUMBER: 1877734-2009 <br />n CERTIFICATE 10: 16 <br />gCERTIFICATE EXPIRES: 01-01-201 O <br />� <br />V 01-01-2009/01-01-2010 <br />CITY OF SANTA ANA <br />SHERI BARKLEY <br />20 CIVIC CENTER PLZ M-36 <br />SANTA ANA CA 92701-4058 <br />SG JOB:OPERATIONS OF THE NAMED INSURED <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 />THORIZED RePRESENTATRU PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #iBO0 - THOMAS, ROBERT PRESIDENT TREASURER - EXCLUDED. <br />EMPLOYER <br />R V THOMAS INC. <br />PO BOX 90126 <br />LONG BEACH CA 90809 <br />(REV.2-05) <br />SG <br />[BiT,NC) <br />PRINTED : 02-11-2009 <br />SG <br />