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May 22 09 08:01a Reliable PetroleumA <br />209-845-8953 p.3 <br />11wrvm1Anja - rnS IS -qUt A BILL. SEND NO MONEY UNLESS S—A"NT NT IS ENCLOSED. <br />TAT E HOME OFFICE APFRANCISCO ORKRS' CO PENS ON ORSE E T CERTIFICATE <br />COMPENSATION 1N CONSIDERATION OF THE PAYMENT OF THE TOTAL DEPOSIT PREMIUM AND FULL PREMIUM TO BE COMPUTED AS PROVIDED <br />INSURANCE I,N THE CONTINUOUS WORKERS' COMPENSATION POLICY INDICATED HEREON. IT !S AGREED THAT SUBJECT TO THE <br />PROVISIONS OF SJCH POLICY AND ENDORSEMENTS THERETO. THE EMPLOYER INDICATED HEREON IS HEREBY NAMED AS <br />ADDITIONAL GROUP INSURED EMPLOYER. <br />THISrHIS INSURANCE IS EFFECTIVE FROM n=f+f A®A"rl^ IL - <br />PACIFIC STANDARD • s POLICY�713-08 • • <br />3-01-09 • 0 A ► SHALL GOLDENBUILDERS <br />AUT014ATICALLY RENEW EACH 3-01 <br />UNTIL CANCELLED <br />IT 30678 <br />REZIABLE PETROLEUMSERVICES INC. DEPOSIT PREMIUM $520.00 <br />521 BRANDING IRON ST. <br />VALLEY HOME, CALIF 95361 MINIMUM PRE $520,00 <br />PREMIUM DJU IOD SEMI-ANNUALL <br />WAKE OF O <br />CORPORATION) <br />CUNTERSIGNED AND ISSUED AT SAN FRANCISCO MARCH 16, 2009 <br />SCIF FORM 10962A, (OVER <br />i <br />TRADE NAMES- RELIABLE PETROLEUM SERVICES INC. <br />LOCATIONS- 001 521 BRANDING IRON ST. <br />VALLEY HOME CA 95361 <br />1. <br />WORKERS' COMPENSATION INSURANCE - PART ONE OF THIS POLICY <br />APPLIES TO THE <br />WORKERS' COMPENSATION LAWS OF THE STATE OF CALIFORNIA. <br />- 2..EMPLOYER'S <br />LIABILITY INSURANCE ­ - PART TWO OF THIS POLICY PLIES TO <br />LIABILITY U THE LAWS OF THESTATE OF CALIFORNIA. THE <br />LIMIT OF OTA <br />­ <br />LIABILITY INCLUDING DEFENSE COSTS UNDER PART TWO IS, <br />$1,000,000 <br />CODE NO. <br />PRINCIPAL WORK AND RATES EFFECTIVE FROM 03-01-09 TO 03-01-10 <br />INTERIM <br />PREMIUM <br />BASE <br />BILLING <br />BASIS <br />RATE <br />RATE* <br />BUILDING CONSTRUCTION -SEE EXTENSION SCHEDULE FORM 10500 <br />5027-1 <br />MASONRY <br />21.99 <br />20.67 <br />5028-1 <br />MASONRY <br />13.08 <br />12.30 <br />5140-1 <br />ELECTRICAL WIRING --WITHIN BUILDINGS <br />6.18 <br />5.81 <br />5183-1 <br />PLUMBING --SHOP AND OUTSIDE <br />13.26 <br />12.46 <br />5183-2 <br />REFRIGERATION EQUIPMENT <br />13.26 <br />12.46 <br />CUNTERSIGNED AND ISSUED AT SAN FRANCISCO MARCH 16, 2009 <br />SCIF FORM 10962A, (OVER <br />i <br />