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POLICYHOLDER COPY NF <br /> 29 P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 10-01-2010 GROUP: 000592 <br /> POLICY NUMBER: 0003128-2010 <br /> CERTIFICATE ID: 22 <br /> CERTIFICATE EXPIRES: 10-01-2011 <br /> 10-01-2010/10-01-2011 <br /> INTERNAL USE ONLY NF <br /> 3181 LUYUNG DR <br /> RANCHO CORDOVA CA 95742-6899 <br /> This is to certify that we have Issued a valid Workers' Compensation insurance policy In a form approved by the <br /> California 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 30 days advance written notice to the employer. <br /> We will also give you 30 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 <br /> by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br /> afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br /> 6th.riaed Representative Interim President and CEO <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #1600 - SEAN M. MURPHY, PRES,SEC,TRES - EXCLUDED. <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2009 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> EMPLOYER <br /> TOWN a COUNTRY CONTRACTORS INC NF <br /> 3181 LUYUNG DR STE A <br /> RANCHO CORDOVA CA 95742 <br /> M0410 <br /> PRINTED : 09-17-2010 <br /> (REV.1-2010) <br />