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CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />RECEIVED GROUP: <br />ISSUE DATE : 01-13-2010 MAITY OF RIVERSIDE <br />n POLICY NUMBER: 1826692-2009 <br />JAN 2a10 CCERTIFICATE ID: ERTIFICATE EXPIRES: 12901-2010 <br />12-01-2009/12-01-2010 <br />Pv 7_ <br />RISK MANAGEME <br />CITY OF RIVERSIDE <br />3900 MAIN ST <br />RIVERSIDE CA 92522-0001 <br />SK <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 />``Z ~ <br />T HORIZED REPWRESENTATIV~gj PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2010-01-13 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: <br />CITY OF RIVERSIDE <br />ENDORSEMENT #1600 - FERNANDO ESTRADA PRES,SEC,TRES - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-2007 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />ENDORSEMENT #2001 ASBESTOS CERTIFICATION EFFECTIVE 12-01-2006 IS ATTACHED TO AND FORMS <br />A PART OF THIS POLICY. <br />EMPLOYER <br />F E SERVICES INC <br />8891 MISSION BLVD <br />RIVERSIDE CA 92509 <br />SK <br />[LDH,CS] <br />SK <br />EV.2-05) PRINTED : 01-13-2010 <br />