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STATE POLICYHOLDERfY Si V 1 ATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION IN S U R A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-01-2007 GROUP: POLICY NUMBER: 1511718-2007 CERTIFICATE ID: 37 CERTIFICATE EXPIRES: 04-01-2008 04-01-2007/04-01-2008 CONTRACTORS STATE LICENSE BOARD SJ LICENSE NUMBER:LIC 631479 WORKERS COMPENSATION UNIT INCEPTION DATE:04-01-2007 P 0 BOX 26000 00:5J SACRAMENTO CA 95826 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. l.� tTHORIZEfl REPRESENTATI PRESIDENT UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1 ,000,000 PER OCCURRENCE, EMPLOYER TAFOYA 8 ASSOCIATES So 15471 RED BARN COURT CHINO HILLS CA 91709 M0409 PRINTED : 03-16-2007