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ST <br /> P.O. BOX 807,SAN FRANCISCO,CALIFORNIA 04101-0807 <br /> PONSATION <br /> 1 rd SUR ArVGC <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> JANUARY 15. 1988 <br /> POLICYNUMSER: 059-SF UNIT 0000225 <br /> CERTIFICATE EXPIRES: <br /> SAKI JOAQUIN LOCAL HEALTH DISTRICT jt � <br /> 1601 . EAST HAIELTON AVENUE ilt r i< !.;:y i`! <br /> CA 95 201 4 <br /> ,1Ai -. . <br /> L ENVIRO:MENTAL HEALTH <br /> FEN,M11/SERVICES <br /> This is to certify that we have issued a valid Workers`Compensation insurance policy in a form approved by the California <br /> Insurance Commissioner to the employer named below for the policy period indicated. <br /> i <br /> This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. <br /> We will also give you TEN 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 by the <br />! policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with <br /> respect, to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br /> described herein is subject to all the terms, exclusions and conditions of such policies. <br /> PRESIDENT <br /> EMPLOYER <br /> ; r <br /> STEPHEN W;. HEDMAf� & LIMDA HEDI�IAM <br /> . WAYNE ORILLIN6 COMPANY 1 <br /> P.0.,.-80x -726' <br /> LINCOLN <br /> LCA 95648 <br /> 5CIF 10262(REV 10-86) <br /> 4 OLD 262A 1 <br />