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ry V V CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> 9EC E'01- E + 22, <br /> 19 ,.oOLICY NUMBER; `7;,_C7 UPdIT QOC2 <br /> CERTIFICATE EXPIRES: 1 O-1 <br /> r <br /> CARL IFARII.0 <br /> 1CC2 RODEC ROAD <br /> PEBBLE &EACH , <br /> CA 93453 J03: 521 AC- C +EROCE_ LANE <br /> LORI. CA 95240 <br /> L TANit T=STI%b <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 /> 30 <br /> This policy is not subject to cancellation by the Fund except uponPX days'advance written notice to the employer. <br /> We will also give you TSN 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 /> V� <br /> PRESIDENT <br /> Ef,D04SE' ;i dT a2005 ENTITLED CERTIFICATE KOLDERS' NOTICE i?FF' CTI�j � <br /> 12/ 21 /d7 IS ATTACHED TC AND FOR",S A PART OF THIS ?;,LILY. <br /> EMPLOYER <br /> ENV►RG��t;,IAL HEALTH <br /> r PERMIT/SERVICES <br /> iF ICHA'L ::. ii A.N OS <br /> r;CO"i <br /> P. C. cOX 1024 <br /> '4E ST SACRaa'::NTC <br /> CA 95oY1 <br /> L <br /> F_ SCIF 10262(REV.10.861 r .Pv clip I,,,I lorn,t cl1 F <br /> OLE)262A <br /> __7 <br />