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
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POLICY NUMBER:
CERTIFICATE EXPIRES: —1 ` "
CITY OF SAt4 ail,,,* C+ P., SIL. iNii
ATTN: DEFUTY CITY CLERK, DA -; ti 3Cm + D. qy
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SAtr' JUAN CAP1Si- ,''ANQ CA 9' v7: JO9W AVENF'NT MARKING MAINT.
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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.
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AUTHORIZED REPRESENTATIVE_ PRESIDENT
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THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262(REV.3-95)