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10/1,9/2004 TUE 09:05 FAX -01 COOP <br /> f <br /> POLICYHOLDER COPY <br /> STATE P.O. BOX 807, SAV FRANCIScQ,CA' 94142-0807 ' <br /> COMPMNSATION I <br /> IN 5UFRANC'r i <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE i <br /> i <br /> ISSUE DATE! 10-01-2004 GROUP: <br /> POLICY NUMBER: 1759401-2004 <br /> CERTIFICATE ID: J22 <br /> CERTIFICATE EXPIRES; 10-01-2005 <br /> ' 10-01-2004/10=.01-2005 <br /> SAN. JOAQVIN COUNTY ENVIRONMENTAL NF <br /> 3R4, E }RESER AVE ,3RD FLOOR <br /> STOCKTON to 9 202 <br /> , <br /> 3 <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a 4prtril'7apprpvgdiby the ' <br /> California,Insurance Commissioner to the employer named.br&low for the policy period indicated.' <br /> This policy is not suhjeet to cancellation by the Fund except upon 30 days' advance written notice to the employer. <br /> We will also give you 30.-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 aflorded <br /> by the policies listed'her "ei4.,Notvvithstandirl9 any requirement, term, or condition of any contractor other document <br /> with respect to which [iris certificats df insurance .may be: issued or..may perthin. the insurance iafforded by the <br /> policies described herein is subject to'all-the terms exclusions end conditions of SuCh policies. <br /> AUTHORIZO,REPRESENTATIVE PRESIDENT <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS; 9;1,000,000.00 PER OCCURRENCE. <br /> ENUURSEME T. #ip ENTITLED CERTIFICATE NOLDEftt",NOT;cr;EFFECTIVE 10-01-2004 IS ATTACHED TO AND l <br /> FORMS A PART OF THIS 001_ICy. l <br /> n <br /> EMPLOYER LEGAL NAME <br /> V E W DRILLING.: INC. V & til DRILLING, ,;CNC- <br /> PO BOX'klb <br />!i ISLETON CA 9564.1 <br />' (eev.3-05l pRINTEp09/17/2004; P0410 it <br /> THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND 0265 <br /> I' <br />