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STATE P.O. BOX 807, SAN FRANCISCO,CALIFORNIA 94101-0807 <br /> COMPENSATION <br /> I N S U R A N C E <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> NOVEMBER 30♦ 1917 POLICY NUMBER0152931 — 87 <br /> CERTIFICATE EXPIRES: 5-17-88 <br /> ' SAN JOA9UIN LOCAL HEALTH DISTRICT <br /> P 0 sox 2009 <br /> STOCKTON <br /> CA 95201 <br /> L <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 /> 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 /> X. <br /> EMPLOYER <br /> F- <br /> CLEMENTS RURAL COUNTY FIR£ DIST <br /> P 0 BOX 523 <br /> CLEMENTS <br /> CA 95227 <br /> L <br /> SCIF 10262 (REV. 10-86) OLD 262A <br />