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STATE <br />COMPENSATION <br />I N S U R A N C E <br />FUND <br />ISSUE DATE: 05 -01 -2015 <br />CITY OF RIVERSIDE <br />RISK MANAGEMENT <br />3900 MAIN ST <br />RIVERSIDE CA 92522 -0001 <br />CERTHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />NF <br />GROUP: <br />POLICY NUMBER: 9054686 -2015 <br />CERTIFICATE ID: 6 <br />CERTIFICATE EXPIRES: 05 -01 -2016 <br />05 -01- 2015/05 -01 -2016 <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 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 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 />d....-7,,,--1 . ..e.r.--Pz."---•—• <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - KINGDON, WILLIAM CECIL, P,S T - EXCLUDED. <br />EMPLOYER <br />W C KINGDON INC <br />28035 SEA BISCUIT ST <br />MORENO VALLEY CA 92555 <br />(REV.7 -2014) <br />NF <br />PRINTED : 04 -18 -2015 <br />M0408 <br />NF <br />