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- is ►� Y `" - �.. - Tom. <br /> STATE �- <br /> � � y <br /> P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 <br /> COMPENSATION <br /> INSURANCE <br /> RV N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> POLICY NUMBER- <br /> CERTIFICATE EXPIRES <br /> r <br /> L <br /> This is to certify that we have issued a valid Workers'Compensation insurance policy in a lifornia <br /> 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 290 days'advanr uyer. - <br /> 30 <br /> We will also give you T)F* days'advance notice should thispolicy be cancellr on. <br /> This certificate of insurance is not an insurancelic and does <br /> Y not ,verage afforded by the <br /> policies listed herein. Notwithstanding any requirement, term, or w other document with <br /> respect to which this certificate of insurance may be issued x afforded by the policies <br /> described herein is subject to all the terms, exclusions and Gond' <br /> I <br /> I <br /> I <br /> EMPLOYER <br /> r � <br /> i <br /> L <br /> SC1F 10262(FtEV.6-64) OLD 262A <br />