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1993-0517_BOTACO, INC._Workers' Comp Insurance0 r STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMrINSATION 1 N 5 U R A N C C FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE MAY 17, 1993 POLICYNUMBER:1332443 — 93 CERTIFICATE EXPIRES: 1-1-94 CITY OF SAN JUAN CAPISTRANO ATTENTION: CITY CLERK 32400 PASEO ADELANTO SAN JUAN CAPISTRANO, CA 92675 THIS SUPERSEDES AND CORRECTS THE CERTIFICATE ISSUED ON 04-21-93. JOB: ALL OPERATIONS 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 poli3y0 period indicated. This policy is not subject to cancellation by the Fund except upon yep days' advance written notice to the employer. 30 We will also give you TAXI 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. vf� X. PRESIDENT EMPLOYER'S LIABILITY LIMIT: $3,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04/21/93 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER F— BOTACO, INC. AND/OR BOTA PACIFIC INC. DBA: BOTACO/BOTA PACIFIC 31921 CAMINO CAPISTRANO SAN JUAN CAPISTRANO, CA 92675 L SCIF 10262 (REV. 10-86)