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Aug 22 06 10,09a David Fisch .� 2Q9-772-3571 p,1 <br /> POLICYHOLDER COPY NK <br /> STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> COMPENSATION <br /> INSURANCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 06-08-2006 GROUP. 000229 <br /> POLICY NUMBER: 0029068-2006 <br /> CERTIFICATE ID: 72 <br /> CERTIFJCATE EXPIRES: 08-01--2007 <br /> 08-01-2008/08-01-2007 <br /> CONTRACTORS STATE LICENSE BOARD NK LIC PERMIT II: 583865 <br /> WORKERS COMPENSATION UNIT INCEPTION DATE:08-01-2006 <br /> PO BOX 26000 DO.-NK <br /> SACRAMENTO CA 95826-0026 <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 upon30 days advance written notice to the employer. <br /> We will also give you 30 days advance notice should this pahcy be cancelled prior to :ts 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 otherr document <br /> Nuith 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 /> t:IFU�IZLEaCl REPRESENTATI " PRES!DENT <br /> UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br /> THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br /> EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL'LIABILITY INSURANCE POLICY ALSO AFFORDING <br /> CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br /> COMPENSATION LAW. <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01--2004 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> EMPLOYER <br /> FISCH, DAVID AND FISCH, CHRIS DBA: FISCH NK <br /> ENVIRONMENTAL CONSTRUCTION CO. <br /> 394 SHERIS PL <br /> VALLEY SPRINGS CA 85252 <br /> [P.WB,CN] <br /> IREV.2-05} PRINTED 08-08-2006 <br /> RECEIVED TIME AUG. 22. 10: 04AM <br />