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e <br /> STATE P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 <br /> COMPENSATION <br /> I N S U R A INC E <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> December 12 , 1986 POLICY NUMBER: 219955-86 <br /> CERTIFICATE EXPIRES: 10-1-37 <br /> r <br /> County of San Joaquin <br /> T3uilding Department <br /> 1810 E. Hazelton Street <br /> Stockton, CA 95205 <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 /> EMPLOYER <br /> r <br /> James F. Culbertson <br /> 641 N Pacific Ave <br /> Lodi, CA 95240 1J <br /> L <br /> SCIF 10262 (REV.10-86) OLD 262A <br />