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MMI iiM11110:tiIi7:YI <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07-24 -2014 GROUP: <br />POLICY NUMBER: 9036S97 -2014 <br />CERTIFICATE ID: 18 <br />CERTIFICATE EXPIRES, 01-01 -2015 <br />01- 01- 2014/01-01 -2015 <br />SANTA ANA ZOO SK <br />ETHAN FISHER <br />1801 E CHESTNUT AVE <br />SANTA ANA CA 92701 -5001 <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 30 days advance written notice to the employer. <br />We will also give you 30days 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 President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE. COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - TAYLOR, JOHN MICHAEL P - EXCLUDED. <br />ENDORSEMENT #1600 - TAYLOR, KAREN E S,T - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06 -02 -2014 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />JOHN TAYLOR CONSTRUCTION, INC <br />1335 HEDIONDA AVE <br />VISTA CA 92081 <br />EV.I -2012) <br />RECEIVE: NO.0399 <br />SK <br />07/24 /2014 /THU 01:46PM <br />TO FORM <br />Attorney <br />[SMA,CNI <br />PRINTED : 07 -24 -2014 <br />SK <br />Santa Ana Zoo '.. <br />