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CERTHOLDER COpy STATE COMPENSATION INS U FtA N OE FUND P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 .. ... - CERTIFICATE OF.'. WORKERS" COMPENSATION, INSURANCE ISSUE DATE: 05-01-2005 GROUP: POLICY NUMBER: 174145i\1~t1ANAGEMENT . CERTIFICATE 10:.. 48 CERTIFICATE EXPIRES: 05-01-2006 .. ,05-01';'2005/05-01-2006 CI TV OJ R I VE:RS I OE 3900 MAIN STREET . RIVERSIDE CA 92522. $\1 RECEIVED :~ny OF R1VERSIDf APR 2 5 2005 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 30 days' advance written notice to the employer. We will also give you 30 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. Notwithstimding liny requirement, term, or conditiQnof any contract or other document with respect to which this certificate of insurance may. b'& issued or may pertain. the insurance afforded by the policies described herein is subject to all the. terms,exclL.is,iOhs and conditions of such policies. ~ ~ ~~~ AUTHORIZED' REP~ESENT ATIVE PRESIDENT . .' '.... .-'.-q'. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE costS: $1,000,000.00 PER OCCUAAENCE, SCANNED MAY 0 5 2005 .~ 4~5~' ~~~~~:U~~~O~h' ~c '. .'. Finance/Risk Mgmt CH I NO CA 9171 0 EMPLOYER H H. S. CONSTRUCTION, INC (REV.3-03) PRINTED' THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND sell 102(,