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POLICYHOLDER COPY NE <br /> P. Q. BOX 8192, PLEASAA tOIA, CA 945.88 <br /> ■ <br /> CERTIFICATE OF WORMS' COMP.ERSAT10i•7 INSURANCE <br /> ISSUE DATE : 1i -Oi -2019 <br /> GROUT <br /> POLICY NUMBEfi 1308371 - 2019 <br /> CERTIFICATE IG. 173 <br /> CERTIFICATE EXPIRES: 11 - 01 -•2020 <br /> 11 -01 -201 $ / 1101 -2020 <br /> CONTRACTORS STATE LICENSE BOARD <br /> NE LIC PERMIT : 804904 <br /> PO Box 26000 INCEPTION DATE : 11 - 01 -2019 <br /> BdCRAPiEt'iT0 CA 9586- 0026 Dog NE <br /> This is to certify that we have. issued a valid Workers' Compensation fnsurxlee policy in a form approved by the <br /> California Insurance Comm' lssione' to the employer named belosv for the policy period indicated, <br /> This policy is not subject to cancellation by the Furid except upon 30 days advance written notice to the employer. <br /> We will also give you 30 days advance notice should this policy abe cancelled prior lb ils normal expiration. <br /> This certificate of Insurance is not an insurance policy and does nbt amend, extend or alter the coverage afforded <br /> by the policy listed hereto. Notwithstanding any requirement, term at condition of any contract .or other document <br /> vyith respect t0 which this certlflcate of .insurance may be issued or to wHfch it may pertain. the insurance <br /> afforded by the policy described herein is subldct tO all the terms. exclusions. and conditions, of such policy, <br /> A " <br /> AUthorixed Representative , President and CEO <br /> Eh[PLOYERIS LIABILITY LIMIT INCLUDING DEFENSE COSTS : Si , O0t7, 000 PER OCCURRENCE , <br /> ENDORSEMENT #2066 ENTITLED CERTIFICATE HOLDERV NOTICE EFFECTIVE 11 - o1 -2016 Is <br /> ATTACHED TO AND FORMS A PART of THIS pOLICy , <br /> .1 it <br /> 94 , € _ <br /> V <br /> 7 <br /> I <br /> i <br /> EMPLOYER <br /> j OEWE UST S$[iVIOSS INCs Na <br /> MEAGHM RD <br /> ►FIELD CA 8,3314 <br />