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<br />CERTHOLDER COpy <br /> <br />SL <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />MAR 2 6 2001 <br /> <br />GROUP: 000467 <br />POLICY NUMBER: 0000763-2007 <br />CERTIFICATE ID: 17 <br />CERTIFICATE EXPIRES: 04-01-2008 <br />04-01-2007/04-01-2008 <br /> <br />ISSUE DATE: 04-01-2007 <br /> <br />RECEIVED <br />:;ITY' Or.: RIVERSIDE <br /> <br />CITY OF RIVERSIDE <br />3900 MAIN ST <br />RIVERSIDE CA 92522 <br /> <br />RISK MANAGEMENT SL <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <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 /> <br />a:::-REPRESENTATI ~ <br /> <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br />EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br />CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />COMPENSATION LAW. <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br /> <br />APPRCMiOM TO'FORW <br /> <br />/au. 'qI1Rr:tC~E~7 <br /> <br /> <br />EMPLOYER <br /> <br />SENTENO,LOUIS DBA:u & D PLUMBING <br />414 S SAN GABRIEL BLVD <br />SAN GABRIEL CA 91776 <br /> <br />SL <br /> <br />M0408 <br /> <br />PRINTED <br /> <br />03-16-2007 <br /> <br />(REV.2-051 <br />