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i <br /> STATE P.O. BOX 807,SAN rRANCISCO,CA 04101-0807 <br /> COMPENSATION <br /> I'N6URANCH <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> A1iGUST L •'-i 1991 POLICY NUMBER: <br /> CERTIFICATE EXPIRES: <br /> r- <br /> CONTitACTOR ' S STAT F. LICI^;\IrVE FA f' RD <br /> P a box ?uboo <br /> SACP,AM,NT? CA 95rirE <br /> Flbc441 <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,, pulicy period indicated. <br /> This policy is not subject to cancellation by the f=und except upon ten days' advance written notice to the employer. <br /> We will alio give you TEN days'advance notice should this policy he cancelled prior to its normal expiration. <br /> This certificate of insurance is not an insurance policy and docs not amend, extend or alter the coverage afforded by the <br /> policies listed herein. Notwithstanding any requirement, term, or condition of any rontract 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 I;olicies, <br /> PRESIDENT <br /> �I V <br /> v JAI <br /> EMPLOYER <br /> �- <br /> ENVIRONMENTAL HEALTHRICES <br /> APTFSIAI.' ENVIROP:I, hTL CI ± ; <br /> 100 SHOPEI-1NL HV'Y 4295 <br /> I• ILL VALLEY CA 9491 <br /> (_ u�G 7f2F <br /> CQPY FOR INSUIiED'S FILO <br /> SC:IF 10,162(REV. 10.86) <br />