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CERTHOLDER COPY <br /> NJ <br /> STATE <br /> P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 11-04-2011 GROUP: 000713 <br /> POLICY NUMBER: 0007383-2011 <br /> CERTIFICATE ID: 581 <br /> CERTIFICATE EXPIRES: 10-01-2012 <br /> 10-01-2011/10-01-2012 <br /> PINNACLE ENVIRONMENTAL, INC. NJ <br /> PO BOX 1956 <br /> PARADISE CA 95967-1956 <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br /> California Insurance Commissioner to the employer named below for the policy period indicated. <br /> This policy is not subject 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 ano does not amend, extend or alte• the ccverage afforded <br /> by the policy listed herein. Nctwithstanding any requirement, term or condition of any contract or cther document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the 'insurance <br /> afforded by the policy described herein is suoject tc all the terms, exclusions, and conditions, of such policy. <br /> Authorized Representative President and CEO <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #1700 - DONALD BURTON SILIGO - EXCLUDED. <br /> ENDORSEMENT #1700 - DENNIS JAMES OTT - EXCLUDED. <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2005 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> EMPLOYER <br /> SILIGO, DONALD BURTON (PARTNER)AND AND OTT, <br /> DENNIS JAMES (PARTNER) <br /> PO BOX 6093 <br /> OROVILLE CA 95966 <br /> [B14,NJ] <br /> PRINTED 11-04-2011 <br /> (REV.8-2010) <br />