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P.O. BOX X20807,SAS!FRANCISCO,CA 94942 t?8D7 <br /> co p;N ar:ii v <br /> ' surto AN0,E <br /> FUND II ; T ICINI INSURANCE <br /> DECEMBER 3, 2001 POLICY NUMBER: <br /> UNIT 000tk273 <br /> CERTIFICATE EXPIRES: 10-1-02 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH:SERVICES <br /> ENVIRONMENTAL HEALTH DEPT <br /> 304 E WEBEAVE 3RD. F'LR <br /> STOCKTON CA 95202- 2777 B: CHEVRON 1103 S MAIN ST <br /> A TECA CA <br /> L- <br /> This is to certify that we have issued a valid Workers Compensation Ansurance policy in a form approved by the California <br /> Insurance Commissioner to the employer named below,for the po period indicated. <br /> This policy is not subject to cancellation by the Fund except uponX)fn days'advance written notice to the employer. <br /> 30 <br /> We will also give you N 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 contractor 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 /> AUTHORIZED REPRESENTATIVE PRESIDENT <br /> , ,EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1P0001000 PER OCCURRENCE- <br /> ENDORSEMENT #2065 ENTITLED CERTIFCATE HOLDRS' NOTICE EFFECTIVE <br /> 12/03/01 IS ATTACHED TO AND FORMS A PART OF ''THIS POLICY. <br /> EMPLOYER <br /> SAVIDGE CONSTRUCTION IIC <br /> 140 SONJktl <br /> -PLACERVILLE ' CA 956,67' <br /> Lir ' <br /> WON <br /> I <br />