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NF <br />CER" 'OLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />IN SU-RANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 02-09-2003 GROUP: <br />POLICY NUMBER: 1616839-2003 <br />CERTIFICATE ID: 2 <br />CERTIFICATE EXPIRES: 02-09-2004 <br />02-09-2003/02-09-2004 <br />GLACIER ENVIRONMENTAL SERVICES INC <br />12521 EVERGREEN DRIVE SUITE A <br />MUKILTEO WA 98275 <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 beiow for the policy period inoicated. <br />This policy is not subject to cancellation by the Fund except upon 10 days' advance written notice to the employer. <br />We will also give you 10 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 policies 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 may pertain, the insurance afforded by the <br />policies described herein is subject to ail the terms, exclusions and conditions of sucn policies. <br />AUTHORIZED REPRESENTATIVE <br />A;,t�� �'. ML <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000.00 PER -OCCURRENCE. <br />ENDORSEMENT X0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 02-09-2003 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />NAME OF ADDITIONAL INSURED: GLACIER ENVIRONMENTAL SERVICES INC <br />EMPLOYER <br />GLACIER CONSTRUCTION SERVICES INC <br />12521 EVERGREEN DR STE A <br />MUKILTEO WA 98275 <br />LEGAL NAME <br />GLACIER ENVIRONMENTAL SERVICES, INC. <br />01-18-2003 PO4bEl <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND _ lsciF 10265 (REV. 2-01) <br />