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Rpr 15 04 08: 19a -Va td Pacific Petroleum 2093 1619 P• 3 <br /> • r vvrv91AVVtIVIS YL,c <br /> HT <br /> W <br /> �� PO BOX 807, SAN FRANCISC0,CA 94101-0807 <br /> Ry CERTIFICATE OF W0W- RS' COMP NSAT10N INBURANCB <br /> POLICY NUMBS: 044-02 UNIT 0003648 <br /> ISSUE�KlAT@: ,10-01-02 CERTIFICATE EXPIRE& 10-01-00 <br /> ,i <br /> P NT;ACTOfiS`. StATE LICENSE BOARD doe: aaefosa <br /> �i :,wv%B.WOh0EE4SATIQN .UNIT zNcePTIOK DATE: 10-01-02 <br /> D.O. : SAKERSFIELO <br /> SACAAMENTO'U 95826; <br /> This is to cattily Mat we have issued a valid Workers' Compensacon insurance policy In a form approved by the <br /> Ca11Renla,bj8'Jenoe COl Milleloner to the employer named below for the policy period indicated. <br /> This p0116Y 76 not:subject to cancellation by the Fund except upon 20 days' advance written nOtiee to the employer. <br /> We wIll..ay0e:9Wa.YeV„3prdij3^All ince notice should this policy be cancelled prior to its normal exPlradon. <br /> This A 1 n/tkance ie not an Insurance policy and do” not •mend, axtend or after the Coverage afforded <br /> by-, r VI hol'N,¢`N6iwlthstsnckV any.rgquwjjm@M, term, or cdndidon of my contract or other document <br /> with re lo- this 0,1111cste of Idswanpe jAe'y.bb Issued or may'pertalm-the Insurance afforded,by the <br /> '.'pollaias herein Is subJeot to ail the twmr.-ex21us,0ns and eonditipni of such polleles. <br /> M I <br /> r�Y ,i�'t PRESIDENT <br /> flfPl:O td� I"VL <br /> JTX L"IT IPCLU61NO DE FRO; C06F5 Etv 0,0(�,000 00 pCR-;OCWRRENCE. <br /> ,Z k )lMBN.ti`t•j/DOg� ENTI�iTL D CCRTIFICAT4 ObUIRS' WTIOE BFFEC'fjVt 10/01/02 IS ATTACHED TO AND <br /> F � OR"TNI! ftLCT r r <br /> 'CA ''e: 1. :•wue.::. <br /> 7 �L <br /> r 1:: <br /> y it <br /> PiiMPLOY�I. -r 4 .I •' LEGA NAME <br /> t <br /> p! - <br /> KCJ CQNY CNC. CON9TRLCTION, INC. <br /> 4 r nom.pV °Il wi PRINTER 00-1e-02 PO410 <br /> r a a . 114111911--l- <br />