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V <br /> m <br /> Mme: 5404- 110 STATE OF CALIFORNIA <br /> DEPARTMENT OF INDUSTRIAL RELATIONS <br /> OFFICE OF THE DIRECTOR <br /> AFFILIATE CERTIFICATE OF CONSENT TO SELF-INSURE <br /> THIS IS TO CERTIFY , That <br /> Liberty Aura! County Fire Pro tec tion Dis tric t <br /> has complied with the requirements of the Director of Industrial Relations under the provisions of <br /> LdSections 3700 to 3705, inclusive, of the Labor Code of the State of California and is hereby <br /> w granted this Affiliate Certificate of Consent to Self-insure, as a memeber of a joint powers <br /> authority granted the Master Certificate No. 5404 <br /> This certificate may be revoked at any time for good cause pursuant to Labor Code Section 3702. <br /> EFFECTIVE DATE : September 1, 1992 <br /> 1 DEPARTMENT OF INDUSTRIAL RELATIONS <br /> OF THE STATE OF CALIFORNIA <br /> m <br /> N MANAGER,SELF INSURANCE DIRECTOR, DEPARTMENT OF INDUSTRIAL RELATIONS <br /> m <br /> m <br /> N <br /> Q1 <br /> N <br /> \ FORM A-4-10A (REV. 1W) <br /> m <br />