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1998-0206_CALIFORNIA TRAFFIC MAINTENANCE_Workers' Comp Insurance STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE r ^ !, vd ',,,,r c ',:",_? i UNIT 00076e9 POLICY NUMBER: CERTIFICATE EXPIRES: —1 ` " CITY OF SAt4 ail,,,* C+ P., SIL. iNii ATTN: DEFUTY CITY CLERK, DA -; ti 3Cm + D. qy 3240U P A'SE'.e 4 6a i:.I_ �.`4 T SAtr' JUAN CAP1Si- ,''ANQ CA 9' v7: JO9W AVENF'NT MARKING MAINT. AND REMOVAL e. 0. ;1506 41 L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer. We will also give you TEN days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ...,-,...4,...66,....„ ,,7,-,7;7„,,_ ,,,iprez„,,„____ " 1 AUTHORIZED REPRESENTATIVE_ PRESIDENT EMPLOYER S LIA9•1L _TY LIMIT It,ICL''J'iif':i DEF -NS: ;, . _ y j , _ '' . UQU PCR OCCURPENCF rn (` M --.. cs ? :* ', EMPLOYER rn tifiir lsr1, .=' rri p v �, ILP < T APUt7AC`r. a' D3A: CALIFORNIA TI FF. C m4I iTE'4. ALEco 1731 N. CLIFOrNIP Sir � , r , 6ut�' ANaC C�1 a'1 b0j �i .:: r :a + - ' ,. �''.. ' _ , ». L THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262(REV.3-95)