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26 04 04: 1Op WESTER <br /> NN B CO. (916) 373-0548 p, 3 <br /> x <br /> ..r P.0202 <br /> POLICYHOLDER COPY <br /> STATE P.O.BOX 420807, SAN FRANCISCO, CA 94142-0807 <br /> COMPENSATION <br /> 1 N 5 V R A N C G <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 08-26-2004 <br /> GROUP. <br /> POLICY NUMBER: 1569784-20041 <br /> CERTIFICATE ID: 2141 <br /> CERTIFICATE E1(PIRFS: 02-01-2005 <br /> tt2-0I-20041/02-o1-2005 <br /> sAN .roAQvar cot7NTst <br /> 722 E. pEDHER AVENGE ROOM 675 <br /> STOCETON CA 95202 <br /> This is to certify that we have issued a valid Worker's Compensation insurance policy et aform approved by Inc.Calilornia <br /> Insurance Commissioner to the employer named below for the poficy period Indicated. <br /> This Policy's not subject to cancellation by the Fund except upon 3D days advance written notice to the employer. <br /> We wiG also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> This Bested he ei insurance is not an insurance policy and does not emend,extend or alter the coverage afforded by the <br /> respect to Which Policy listed heroin Notwithstandininsurance g any reQOirembe ent,term or corxiidon of any contract Or other document w%h <br /> described herein is subject to all the terms,exc may <br /> ons and conditions.Ued of of such policy;the insurance afforded by the policy <br /> CC/ ' ,(dam; c . <br /> AUiIWHRED GEPRESEMATIVE <br /> Pncsrorxr <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,Otto PER OCCMUUMCE. <br /> F-NDORHEl�NT #1600 - SYLVIE JENSEN, P, 8, T - EXCLUDED. <br /> ZNDORSFZUZrr #2065 ENTITLED CERTIFICATE ROLUERS' <br /> ATTAAMMD TO AND FORMS A PART OF THIS POLICY. NOTICE EFFECTIVE 02-01-2004 I3 <br /> FNPIpTEA <br /> rPP.STEX, WESTERN STRATA EXPLORATIOU A CORP <br /> PO Box 657 <br /> CLARRSUURO CA 95612 <br /> TO <br /> TRL P.02 <br />