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47Prt _PUG. r. 1998 2L: S:=IF SAC PROVER 916 924 6338 <br /> STATE P.O.BOX 420807,SAN FRANC15CO.GA 94142-0807 <br /> COMPENSATION <br /> INSURANCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> POLICY NUMSFR+ <br /> CERTIFICATE EXPIRES: IS;ifat.l5-fib <br /> s' a1_90 <br /> PUBLIC 1'I�:'�7i.:�'i SERVIC I..'s <br /> --'AN Jt)Atli UIN i`c 1[-iNTY <br /> ii til '1ltt.�NY,vd l d'd'aI. >i[d�.,4"t'ial 01\15K) <br /> .gidl4 N. W]k AVi . .�Q'I�.I <br /> This is to certify that we have Issued a valid Workers Compensation insurance policy in a form approved by the Cailfornla <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 ten days'advance written notice to the employer. <br /> We will also give you TEN days'advance notice should this policy be cancelled prior to its normal explratlpn. <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 MSM pertain, the insurance afforded bay the pol4cles <br /> described herein is subject to all the terms,excluslon3 and conditions of such policies. <br /> At3THORIZItO AERRE 3 NTgTEVE PFtE81pE l7 <br /> Z_��f'�'�C��'%!C'ti Lr�?�,l'P'�`t..3�.�i;`�'!�{:"�.w`Irs�?�PE_� P�.i����l��'Ct���'i:h �[,rxu.I,��>s�fi(I I'�•It rTa'"t 'l.i!?:f�.[°�+t�'�: <br /> EMPLOYER <br /> FTSO-� DAVID <br /> MCH Y.N11RONTNT.NTAL <br /> CONSIMIJIMION <br /> .399 SI-A:#as PLACE <br /> L `'bk1j_I•r.i VRDQGS CA 95252 '• <br /> SCID <br /> Cs c 3o 'E(AEV.3-05) <br /> ov <br />