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<br />CERTHOLDER COpy <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.o. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />RECEIVED <br />',/TV OF RIVERSIDf <br /> <br />CERTIFICA TE OF WORKERS' COMPENSATION INSURANCE <br /> <br />JAN 27 2009 <br /> <br />ISSUE DATE: 01-13-2009 <br /> <br />GROUP: 000044 <br />POLICY NUMBER: 0025821-2008 <br />CERTIFICA TE 10: 2647 <br />CERTIFICATE EXPIRES: 01-01-2010 <br />01-01-2009/01-01-2010 <br /> <br />RISK MANAGEMEN. <br /> <br />CITY OF RIVERSIDE <br />ATTN BLDG INSPECTION DEPT <br />3901 ORANGE 5T <br />RIVERSIDE CA 92501-3610 <br /> <br />SP <br /> <br />~OB:VICTORIA BOOSTER STATION <br />ARROYO DRIVE & VICTORIA AVE <br />RIVERSIDE CA <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 />Q=:REPRESENT A TI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2009 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />G D HElL INC <br />1640 S CLAUDINA WAY STE FRNT <br />ANAHEIM CA 92805 <br /> <br />SCANNED <br />JAN 28 2009 <br /> <br /> <br />EMPLOYER <br /> <br />[VR1.CS] <br /> <br />'F!:::V.2-051 <br /> <br />Finance/Risk Mgmt. <br /> <br />PRINTED <br /> <br />01-13-2009 <br />