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STATE P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101-0807 <br />COMPENSATION <br />I N S U R A N C E <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />:ECt.'_En 4-2i 1V', POLICY NUMBER: `T ,. Mllz <br />CERTIFICATE EXPIRES: I I <br />r <br />;;ARL YeAR11,C <br />1CC2 RODEC .JAS <br />PE3BLE EEACH <br />CA 93453 <br />Jo--: 521 NC. CrIEROKEE LANG <br />LODIi CA 9524D <br />TANK T=STI>6 <br />L <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 indicated. <br />:U <br />This policy is not subject to cancellation by the Fund except upon ten, days' advance written notice to the employer. <br />We will also give you TEN 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 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. • ,a . _ <br />PRESIDENT <br />cr.0 ::cr,E.dT a'Oo5 Ei:TLTLED CERTIFICATE MOLDERS' r,OTICE EFFcZTIwE <br />i[/_1/.;7 IS ATTACHED rC AND FORxS A PART OF THIS PCLICY. <br />EMPLOYER <br />r <br />MICHAEL S. kAMOS <br />Dc A: P:MCON <br />P.C. a0a 1024 <br />.ZEST 5A:9AMTNTC <br />CA 95oY1 <br />L <br />JAN 6 <br />P98� <br />ENVIkUMEv7AL HEALTH <br />FERMIT/SERVICES <br />