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Yh� COPY <br /> STATE P.O. BOX 807, SAN FRA1NCISCXXCA 94142-0807 <br /> INISuw^Nce <br /> FUND �-m 4F 'NOS�KI2RS` t I SATION N ISURANM <br /> LESLIE OATS 04-11-2005 G7ctp <br /> POLICY fVamx4t 1684846-2006 <br /> SATE 0 1 <br /> CeKTPICATE txpv Est 04-11-2006 <br /> 04-11-2005/04-11-2006 <br /> CONTRACTORS STATE LICENSE BDARD !MF LrcocE NLRIRER: r7424go <br /> WORKERS COMPENSATION UNIT INCEPTION DATE: 04-11-2005 <br /> P 0 80X 26000 <br /> S1�CSll►1WE1i'T4 �!� g583b <br /> This is to certifx drat we ton iw,ed a wRid Workers term '"sLffance Pa" in a form approved by tM <br /> Cakfornia Insurance Ccmmissiww to the wq**Yw named below for the Policy Period indicated <br /> This Pcft7 is not supject to carvellaWn by the Fund except upon 30 days' adwrtce written notice to the employer. <br /> YFe w-A *so *ft you 30 days advance notice should "S Policy be cancelled prior to its nonrral expiration. <br /> n1+ '*W of*Www oa is not an kourance poNcy and does not amend, extend or Sher the coverage afforded <br /> MIN ' to "hu* tlds certiii.rate 8"OV WW rt r tam. or condition of any contract or ewer dock <br /> ts*ahofkes detitl*"1►ereiir�is Vgbl�to ori the ternary ekak" and conditions of anea aftacdad%" +bue <br /> Pdreies. <br /> PRESIDENT <br /> EMPLOYER'S LIMILITY LIOUT INCL.LMwa OEFENW COSM. *S,0W.40*.4& h6i! OCCWW? E. <br /> ENCO8E"ENT F*mx EWITLEO CERTIFICATE NOLAERS' NOTICE EFFECTIVE 04-11-2006 IS ATTACHM TO AND <br /> fOWIS A PART Of TMIS POLICY. <br /> EL+PLOYM LEGAL NAME I <br /> ALPHA PETROLEUM SERVICES ALPHA PETROLEIAI SERVICES, INC <br /> PO SOX 667 <br /> DIXON CA 95620 <br /> illsll.J-e71 PRrVTE�x 03/17/2005 P0410 <br />