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CERTHOLDER COPY NG. <br /> STATE P.O. BOX 420807, SAN FRANCISCO,t ,' 94142,-0807 <br /> COMPENSATION <br /> INSURANCE <br /> FUND`- CERTIFICATE OF WORKERS, CONIPER"TION INSURANCE <br /> ISSUE DATE: 04-18-2006 GROUP: <br /> POLICY NUMBER: 1472659-2006 <br /> CERTIFICATE ID 835 <br /> CERTIFICATE EXPIRES:04-01-2007 <br /> 04-01-2006/04-01-2007 <br /> SAN JOAQUIN COUNTY NO JOB:EAST BAY MIDO POTHOLE PROD <br /> 1610 E HAZELTON AVE <br /> STOCKTON CA 85205-5232 <br /> This Is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br /> California Insurance Commissioner to the employer named below for the policy period Indicated. <br /> This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. <br /> We will also give you 30days 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 <br /> by the policy listed herein. Notwithstanding any requirement, term or condition of any Contract or Other document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br /> afforded by the policy described herein is Subject to all the terms, exclusions, and Condltions, of such policy. <br /> t0S1Z%EDE5E'NTATI PRESIDENT <br /> i UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br /> THOSE NAMED IN THE POLICY DECLARATIONS AS AN INOIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br /> EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br /> CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br /> COMPENSATION LAW. <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2000 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> I <br /> .i <br /> EMPLOYER <br /> I <br /> tWZ. BW AND CRUZ, DENISE£ DBA: CRUZ BROTHERS <br /> LOCATORS <br /> PO BOX 66766 <br /> SCOTTS VALLEY CA 85067 <br /> [CKS,CNI <br /> tREV,2 0'� PRINTED : 04-19-7006 <br />