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STATE 4L <br />P.O. BOX 807. SAN FRANCISCO, CALIFORNIA 94101-0807 <br />tOM'tNfATION <br />t INSURAfVC9 <br />-V.N CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />''ANCr 11i ly i;St33J7 �$ <br />T POLICY NUMBER. <br />CERTIFICATE EXPIRES: —� — <br />r <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 />j 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. Notwithstancjing any requirement, term, or condition of any contract or other document with <br />(•espect to which this certificate of insurance may be issued or may pertain, the insurance afforded b the <br />described herein is subject to all the terms. exclusions and conditions of such policies. y policies <br />X a411— <br />PRESIDENT <br />L <br />R <br />Cr/ <br />EMPLOYER <br />h f L CC <br />S <br />E ER1�11 / <br />SCIF 10262 (REV. 10-86) COPY FOR INSURED'S FILE OLD 262A <br />ISi�l�i,:�.i':k':tY;J-'Sf��.i:!SY.:i?:tiC•r:"_7ior;�i�ov�rr�r.•,'.71: :,+.:...; � ,,,,,r. --- - - — <br />