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OP M I C COM rl NSATION P.O. BOX*-AN FRANCISCO,CALIFORNIA 94101-0809 <br /> I NI SU RA NCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> OCTO-:ER 27, 191.7 POLICY NUMBER c70-37 Ur,iT 0002318 <br /> CERTIFICATE EXPIRES: <br /> 10-1 <br /> MARL04E PR•ODERT : " S <br /> LOX 211 <br /> SAN, RAFA=L <br /> CA 94'71 ; <br /> 4638-A EAST ,ATERLOC RISA , <br /> L 4�41C-A EAST WATERLOC Q?AD <br /> 4^4�_ 12- 4 EAST <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form a` <br /> 4 ' 46 <br /> c AT`R LO0 S T O C : 7 ^, <br /> Insurance Commissioner to the employer named below for the Policy olic period indicated. PProved by the California <br /> This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. <br /> We will alio 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 /> lev <br /> PRESIDENT <br /> EMPLOYER <br /> r <br /> u^ M 44 sC Jr\ <br /> P. O. B , k 1 ..24 <br /> WEST SACRA %'F4TC <br /> L CA 95691 <br /> SCIF 10262(REV. 10-86) COPY FOR INSURED'S FILEF <br /> OLD 262A <br />