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- <br /> ~ ORM A 4-21 . n <br /> - • 4 . 2848 AiDEN WAY, <br /> Sll1F1115Certificate NO. _1917---------------- <br /> SACRAMENTO. CA 95825 <br /> STATE OF CALIFORNIA <br /> DEPARTMENT OF INDUSTRIAI. RELA C sX- aM�O <br /> Office Tthe CALIFORNIAI� �;/ <br /> SACRAMENTO, ALIFOI'��`_ <br /> (SELF-INSURANCE) MAR 5 1987 <br /> RIDER ENVIROMENTAL HEALTH <br /> Increase or Decrease ,q PERMIT/SERVICESI <br /> WHEREAS, In accordance with Condition(3)of Surety Bond No---------- _BND___210__34__77__________________________ <br /> naming University of the Pacific <br /> 3601 Pacific Avenue <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> STockton, California 95211 <br /> eInsurancC <br /> (hereinafter called Principal)and....... <br /> ____The__________Contin__ntal_________--------___e___ompany___________________ <br /> as Surety;and <br /> 91IMM <br /> WHEREAS, The Director of Industrial Relations has called for an increase in the penal sum of said bond in the <br /> amount of at least___ Ninety_-five_Thousand-----------------------------------------Dollars($___95 a 000:____); <br /> NOW, THEREFORE, In accordance with the provisions of said bond, the penal sum thereof is hereby increased to <br /> ____ Four-hundred_Eleven-Thousand------------------------------------------Dollars($--411,000. ---);and <br /> IT IS UNDERSTOOD AND AGREED, That said increase shall be effective in accordance with the terms, provi- <br /> sions and limitations of said band for all past,present,existing and potential liability of said principal,as a self-insurer, <br /> without regard to specific injuries,date or dates of injuries,happenings or events;and <br /> IT IS FURTHER UNDERSTOOD AND AGREED, That this rider shall be attached to and forma part of said bond. <br /> SUBSCRIBED AND SEALED at_ Stockton,_------- California_-----this_ 2nd__dayof---- UPe-_1986-. <br /> Attest: ALJ University of the Pacific <br /> J _ PrintYpal <br /> x i Chairman, Board of Regents <br /> R. M. Eberhardt <br /> y`--------------- <br /> 7u4 <br /> SUBSCRIBED AND SEALED at-----------------------, --------------------this---------dayof------------19---__. <br /> Attest: EALJ -----Univers ity--of_ the_Pac_ific <br /> Principal -- <br /> By, Financial_Vice_ President_______________ <br /> Robert R. Winterber �� 7i14 <br /> 'If the affixed corporate seal sets forth the corporate name of the principal and the state and date of its incorporation,signature of an executive officer <br /> of the principal need not be acknowledged before a notary.See Section 833,California Corporations Code.Otherwise it must be. <br /> SUBSCRIBED AND SEALED at Rancho_Cordova,_Ca "California this l5th <br /> ---------day of May__ ____19Q6__ <br /> .. e �_ ;$he-Continental _Insurance Com_pany____ <br /> ----------------- -------- <br /> — <br /> Surely <br /> I <br /> By:--- --^'F°cl <br /> ---- <br /> Alan S. Tie <br /> "The bond must be subscribed for the surely in California by a California attorney-in-fact if the corporate seal of the surely sets forth the name of the <br /> surely and the stale and dale of its incorporation, no other evidence of the attorney's authority Is rerpdrell. Otherwise there must be anache'd to the <br /> Mstd a cerlificale under the surety's curpnate seal duly attested by a secretary or assistant s^relary showing(1)the allormy in-fact's authority to <br /> execute the bund and(2)that the authority was in force on the(fair of subscription by the attorney in-fart. <br /> PF=. , is s.osa <br />