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ML-.D 114 7V- 1G b4.1F—SHfYf! l HfVN — w <br /> P.2/3 ) <br /> r <br /> CbMpENSATION P.O. BOX 807,SAN FRANCISCO,Cly 94101-0807 <br /> INSUi�AN�L° <br /> FUND <br /> CERTIFICATE OF WORKt RS'COMPElySATION INSURANCE <br /> -AL(Gii-ST 1 , ; y'' POLICY NUMBER- 1167891 9() <br /> C. ATIFICATE EXPIRES. 1-1-91 <br /> r , <br /> U . T,G ,i 1� �L _'i'JTr.��i�,�VT ;L CON!,ULTAN,T <br /> AT? :;PdTTfiti Vn L T'r�wn�r`` <br /> 1 7 * ti T � ,L ,� 1; Y <br /> N i=0NA G <br /> This is to certify that we have issued a valid Workers'Compensation insurance policy'in a form approved by the California <br /> Insurance Commissioner to the employer named below for,the policy period indic6ted. <br /> This policy is not subject to cancellation by the Fund except upon ten days'adv a Ice written notice to the employer. <br /> We will also give you TEN days'advance notice should this policy be cancelled Aril r to its normal expiration. <br /> I <br /> This certificate of insurance is not an insurance policy and does not amend,,extlend 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 may pertain, the insurance afforded by the policies <br /> described herein is subject to all the terms,exclusions and conditions of such policies. <br /> PRMDENT <br /> F.F Air I hiPL;JY ''w 1-' rr IC`r {�'? I r::U A, RLY m �'PL0Y ^ j. <br /> CAL 1 rC RRN A r - i5;,. wJr`� Y �4i> i Y IQ�4 <br /> IIti T-l_ 1 =N -! IDENT ARISING ;)UT OF f1M0 <br /> C iJ" ,JC ' S ti1Yr N7 AUT �, G aF MALI F0rt!41c T <br /> � A� <br /> E i"_i tri i'1 <br /> cvG vzT i 1i', z r G! +- tL ]=.ATN, -,' 14ALL . 1.IE c+,,TITLEI TO C3MPENI- <br /> ( CALIFORIP 41A, L 130,2 C OD <br /> JNtiIl1iAN' F!1rd) OF CALII•r' l D" - <br /> N.,CT U rC T ;'u Tµ. Litd ^F AtmY STATE OTHi? <br /> ThAN T +:. cT- T C, i "'FLOYEL s A'r _ IC , <br /> � � �'J;_+��1, FCC>al.IFORA.I. <br /> EMPLOYER <br /> r <br /> cNGLEWGC� k <br /> L <br /> SCI 10262(REV.10.86) j QLD 262A i <br />