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POLICYHOLDE Y - NE <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />comPENsATioN <br />1 MSbRANC.E <br />CERTIFICATE OF' WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 05-01-2009 GROUP: 000541 <br />POLICY NUMBER: 0000166-2009 <br />CERTIFICATE ID: 80 <br />CERTIFICATE EXPIRES: 05-01-2010 <br />05-01-2009/05-01-2010 <br />REMEDIATION RISK.MANAGEMENT NE <br />2560 SOQUEL AVE <br />SANTA..CRU2 CA 95062-1429 <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 and does not amend; extend or alter, the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement,term or condition of any contract or other 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 subject to all the terms, exclusions,, and conditions, of such .policy. <br />t.tHORIZED. REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE --COSTS: $1,000,000 PER OCCURRENCE. <br />-ENDORSEMENT 1/2065 ENTITLED CERTIFICATE HOLDERS.' NOTICE EFFECTIVE 07-01-2005 IS <br />ATTACHED TO AND FORMS A PART.OF THIS POLICY. <br />EMPLOYER <br />REMEDIATION RISK MANAGEMENT INC DBA: TRITON <br />CONSTRUCThON <br />2560 SO.QUEL AVE STE E <br />SANTA CRUZ CA 950- ----- - -- -------- —._.. - - ----- — .- --- <br />(REV.2-05) ------ <br />M0410 <br />PRINTED : 04-17-2009 <br />