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CERT OLDER COPY <br /> P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br /> COMPENSATION <br /> IN SU<RANCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 02-09-2003 GROUP:POLICY NUMBER: 1616839-2003 <br /> CERTIFICATE ID: 2 <br /> CERTIFIC 02P <br /> 02-09-2003/02-09-2004 <br /> GLACIER ENVIRONMENTAL SERVICES INC <br /> 1252.1 EVERGREEN DRIVE SUITE A - <br /> MUKILTEO WA 98275 <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 empioyer named below for the policy period indicated. <br /> This policy is not subject to cancellation by the Fund except upon 10 days' advance written notice to the employer. <br /> We will also give you 10 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 policies 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 may pertain, the insurance afforded by the <br /> policies described herein is subject to ail the terms, exclusions and conditions of such policies. <br /> 77 <br /> AUTHORIZED REPRESENTATIVE PRESIDENT <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51 ,000,000.00 PER:, OCCURRENCE. <br /> ENDORSEMENT 110015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 02-09-2003 IS ATTACHED TO AND <br /> FORMS A PART OF THIS POLICY. <br /> NAME OF ADDITIONAL INSURED: GLACIER ENVIRONMENTAL SERVICES INC <br /> y -E <br /> y a: <br /> 21 VL►03 <br /> i t^GLACIE �. <br /> EMPLOYER - LEGAL NAME <br /> GLACIER CONSTRUCTION SERVICES INC GLACIER ENVIRONMENTAL SERVICES, INC. <br /> 12521 EVERGREEN OR STE A <br /> MUKILTEO WA 98275 <br /> 01-18-2003 <br /> PRINTED: P0408 <br /> ainumn, oinwn®m�rw�7�T�Rtifr'i 7'®�1•i_i � _ � _ • <br />