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Insurance - Kilbride - 2002-10-01■ - ,.... 4.}..,3 ter'‘,...- 2 ii, 4: . e' t' Si"-...;.",":$ - ' . $4: ,V, , 1-". 1.,..47c.',.',$.4 -rN44.4c--44- 4..3 Ti..' '..5.(zray ter,4,•,,,. 4fr...„,4•2 ••• II_ IF/ 'I .- .54' •$' '••414' &1•5' A'74. 71- 7 k,e 1,IcA Ct''‘ :4 T i,„. '4 17.1.1 A ,•-•A.C„...„,,,N 77 -At .."-t.;),-^, 4,-SG--„Ta 75,,,,,,.:,.,t s' .„P,,,,,,--r • -.....,,,a f„ i„.... 4, ,.;,,, lc . ... ,s, • 4 -4 - br t ‘• •tt., , ee re. •e t 577( .h- A 4• 4-4 I - 9 i'ic ie , -44., 4 .A".‘.- , „,, r:nix4,e.i2.44.4.1-eq;v3.7A- --e n. -1, ,,,,,„„.4 ' ' -`-'9, -4--zrt`kr'S 7"...? 9, , r-"13' -4- '9--4 -r" *' t. 4, -, 4 ,, 1 ',STATE,f 4 6 -'''lit.41. •‘143 4 BISX",807-1SAKI'.iFFIACISCO',.a 9410;1=0807 *".T414;,; -1.$4. ...“ ?; 124 :14's 4":"%I. '56C1115v1 V•44' aOMPENSAT'IldN'c: -"( : 't ,s: ,E,..15: 4. vane/ ,,--s '• 7i,,x.e. f.4c474F " -ii.i4' 4.' ':- ;",414K)1:gii:rilevefl'71t26'02 ,:a t- Ti N S L-1 Rait4 C lEr; % -,‘,,ty- ?: -- ;'"4 i,;.• , -45 ' - *4 4* ••,'4 -151.• rja- 9>04- S., 544 •fty4-21P,,,V4,-.^, ...--...... 1., '. #4, 41,.A. firiiI it riff'7-3 , rd.:P'77.,,44,' FU Mart CERTIFICATE.TIFICATE.OF -WORKERSi,-COMPENSATION,INSURANCE i.k...-„4-z". i COSTA NIESAIANITallISTRIC144' :* fa 4 t-cir,_ g IC,,', Fi'. 1 •44.44.- 0$1' Ar r A ,Of 4 ,4, le .. 0.11;.. 4.73.7., ., ..d.--? -.4 4- ,454'''• ' 'ciel5s455"4■5142, e fr..; 4t,'.44 , 4‘ kr th C r- A.,, ti4; V ' 2Pi-'isPOLICY NUMBER 135285 ,92. "ci-e ; - .4 '41, c‘I*It' '4'46 J• X • '•' a4,1 4,4 rit 2. tr ., A` ' lir "- ' -, " -4.: .44 tT,''s:i.,,i, ISSUEDATE 1,16-o1-02 ,-;,„ " ertrz-f sr" il.Vi.; CERTIFIC,ATE KEk-AIRES400,701703" ,". - s T.,,,t.N..,,.44,i .t....' , , i,,, ,i. 4 te,,, , ..c., 4;a .*4, 44-- 4 rit.,, 74ii 14.. .„_< „.4 -.'" :?...:, . - S. • '-.,.. .. .4(,.. 1 A. -1 k kk 41`.. ,6 - 7 V , C n"••■•4 '.4., '4.4)1.6a.- ,to 5.,) ".. 1 24, . •4E1'1"',,,,,tE . j."...d2- „t lr's,`.1", "9-294 , Ca,kCla, kjt, 4, . 1 4 4 4".,f-110,111% a 4,7 ".‘A 7.. A7 ,.4.- Ne kki,r-rce 1 -Cr cr,,i •0?it, 14, -,41,„:;71.). ‘.77 7.4 ' ' 4 •,4. 74, 7, 47,-, %,-,4,.., (4' ,,,..,. 'C'' t2 . " r`•'t.,/ 4,47' ''' -il •5.114044. c1F...str) 4'• ifir'4 _ - 'r t...-4' iri,,,A ,y.z ;41.v' '1 ''..'''r. ' - * "t''RI LaSt,lair , ,, . COSTA' MESA. SANITARY D I STR I CT -r ICC t, ,, t -tz h ,„74. „. i ) c k 4,,,e.(I,. Z'c' , c. ca./ ,J,,,,kaCc74."k.- k • „,. ^-el- ..1.. kcI rtr;., 11", • 'cs' 'I:e .4 ir eA.--;IiaII-'.I.1CC,S17e.iiic-4.4:Ir.' •C 4 „ATtN , ROB HAMMERS::: •k-,-(''' g, „a. 4. nor stA..„„• ,- I,* -,,t .. y 4 ye ,,,..4.a s 2 `11,51•4` 5 •51.4"4.2•4'7E? s23LryrAST, 17tH 'STREET STE -209-* - S. i -"=! ----.4;c4=4,-P:-- . - i.,•,,.., , .r. ' -, r-9-....* ,' , . .... .... ./ . cc,- 'IA . ' C fit 4; 4.' 'it? Sr A kIC‘c,aciatir A -C 0 S,TA MESA 'CA 92627 ' , ,,,,,b. 4,4 K ., giArTS, ...i, , -,.. .,s, n• • .„,,,,, .44- „. 1•Sli. 5 (641E,. '4"..6st..: )6.1'4') ' 44 .Y.2447. -17 %.,i1 4 „.,,t ,,,,7,, .7%.•,h '„L 1.).,)s .' i'99 Ill e, "4:4', t. ''''' *1 : *1' t.. L., J ■ dr," 1., :Yet .A5.1 .-.1 Eccy ,...i.i.Hect tk: I cc, C <lc' c • 144 4:A.i "i(42 t cAI,‘ - C Ace) "tg ,I. Nc°,...•c•'4, ''i>A i_ ;; $S ;_kc ThiS,,ISc tO;cectify that v-ve,thave ,i isued a„V-alid,„Workeits:COTTre-erisation:iilincespdlic,j‘iiii a"f Orm'appi-oxed'by the ,Daliforni-4In-stirance Commissioner to the employer nal-inert:below'f ar,-theNtpolicy period indicated C.,1.-'-4 q .. -I- • - ' Yrf - I- --- f. 44 • 7 - 4, ,,Ili , %,,, 1 ' .); ‘...,A r k c k '.. . '', c i-j" ar CI . ..'-'4'-'4C di --C.a. • 'sic,- ''" .f T ri, ,-- -iv' .7 NI. , # ,. .. 4, 4;_,./, 2,4"- , ?V.,' 4 il -4'; -""'- .4 -^"‘ • t" 11.t..1 ''''41 This policy is,not:subject,to cancellation by7.rthe c.,Fund except upon ae.days advance Written'9otics: Jo , -the,employer .„,......c,:oii m ""- iiii.1i -.24'A k 4- "V"'s140/4.:56,6„,••• • , ;I.: , :51;ii 4. lfrai,,. 0.:A t. tj; - ro.- „-t We will also.give-you 30 da'ys' 'advance Fiotice,should this'policy;beacancelled-prior to its normal:expiration s. irt '`. , - T % , • This certificate of insurance is not an insurance Policyand,Zdoes noticam„end,,,extend-or iatter,,the coverage afforded I.:" 4"Tc's, iat by the'policies listed herein. Notwithstanding any -tern or condition of any cofitract-oi,other%document' 'I"41-4,-.. 4 with".respect to which this certificate of insurance.-may.bd'issued'or may pertain,:the-insurance?afforded by:the; ,,j, ' ts s . *, a:44 - policies-described is Subject !? all die terms conditions of such policies" tft 4'-S-,-,-."TiA14. - i A" ! . A.. i • , - ' ,.•ii - .4 , ?r, - „ ,T.:,, -i, A.'7,,g,,,k/- r, r --- , "• -.T. 4,..A'f ,_ ' .47, .', r,..r, --,. - ,;:, e,-;:r. ,t, ,;PRESIDENT,, ., 1,,,,,, -, if cri4-„,411 .. fi'" T Ct. `,0TX _. -,;.., 4' . 'V ); • at ' .. _.'2 ,J.' ‘C,. :";•A".-• EMRLOYER'5-CIABILITY ,LIMIT 'INCLUDING DIEENSE",COSTS $1 000 000 00--PER OCCURRENCE'1,-, % 1/-54-1 . ‘ i -'r" ''-' 4 4.1,.•- ,,,,, 're.445',--•.:..e41:',..."-1•-4 0 i.141.j:\4->.".».2.,.,(,.,V4&',4.t 1, '-„ 4..,--. i,i,t Al.,i 2 ''3I, -c S 'ett1. 1•,-l1.,..n,.1.,4..:.•-,,6 4.4.4.6i1'-7,!,.t.;7‘4ik.l.e 4%.456,4,,•-4t -t.I--t:14A:'4A,t k:-4,4 r,, c•1'.-e1',' 'cl'q 1.... n4'4„'s 1,''.44,"i.,-•..•,r4fb7r 4t37i,4...:i,9.%•.7.4 4 t.^.'-.,,/'''9',.4.-..- E 'N0a k'C a A.r,1,k,+%.".1 e V.,.a1,.„.-V4...4.-.14.1.-%%4 I^1^'.r;.?1 7A 2'?d4 1-4,.,:■1,1.r'..s1.-F6 a 1,-.4rC,i.,6'4,--'',1 6.'-“'.E-etp.5-..'A---S sk Ii'&I.r,0 5 cs ENDOR5EMENT #2065 ENT ITLED;CERTIF!CATE HOLDERS' NOTICE ErFECTIVE10/01/02 II SATTACHEDTOD i FORMSAZPART OF THIS POLICY/ ' v .%1 ' i AL c r1 4 - ' - t 1 eY , '7 . 7 . , 4 . .I 4' 't,r ," 42 44- 1, • , t " V ..s., :. r 'i; 4 .g7 A,, , t c,, - .,, ; 4, 1 y,eki.u•6/..A,,=-t'•,tr,4.A",S.1t.Ca4,It.iri'e2-s.rIe.S°Sis'',,iCr r'.i4.l .*.,. , A ',"... ai•' ',..s.„, „ .V.4:.4f. 11't-l'i ..A44*.,-,,,,pp..44,0 -t..„,,,...u- . . 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',. <1 . -"„v- iiI4”. i'cr. • lIcr IAA-CfatCr'elf kiallf‘CC,-S-ar! 'Ic IICIA4 AttlitISCIAlt 44" "4/1 ,7-, ^77' ..' '7% C....s./4 nt ,N • ;15.4..r"?. h...-n v ..- - , n et.•ett.• lil Vlfir e.tere. e.t '''111.'-1/41- 4.4.Aekt:C' 61,1, -EMPLOYER"0"., , :iita`',:f.'"-, Yiniii -"' "4' 71 ■74,4-1'-'4---'1+-`7-s•-r.s.'"‘or LEuAlt-NAME 44",7,14- -,,,.,pr' ,•''',Lt ,.,..,4.4,:r=v3 't, a ..,. ,,,t,..1-k Ati- ri ) ro' , 1, .4 t• • - el-1e•t-'1"Net,-•49...',4•1 el,Z44.411•An:reeLettpl,r et :F.•:• ..141•••• .-41');Kte V 14-';eti 1 Pttt•*••• e A -.. irs, ,,,-,';- , k1/2m-,tr.,:ct,,,p,,a,,,,$.4„ ..;-brkst,•;:zin',I., -4"st.,": ..,1-7,- -`,... ei, --,. 't r.."it 1 1,-.,../1,1g•54 4.i'ts, P4.* -.ix, ''''' 'i:'• 4,' .;,4 Pif ',TD a-iii.T.T., V. , -,.. ,}94. CO Ye te••. • -, .).1 tee../-;•■•4.l• , •;1•:. ."'tite,ef • n'14; .le• • . ''A...:0• ' eeett•ti si , c"' AMICHAEL- J F1/41 LBRI DE.,1 -',„-'-MIKE;;KILBRIDE'LTD .i,,,kt "..e- :LC 1. - t, +-;.-.'r- A 00 ,P0,BOX 334i. ,,e., -.. : - -i?- Air,- - "it .., ti, ' 1' ' r4' ; NEWPORT, BEACH CAC:92659e ' 's. rf.41 i'' * -'''•• F-'".4e-- i• ' 1, --",•.5'. "<"--1 4}471 -4e ny,nett9- ' - ., • ,,t, ••t- '' VC&4,1 ,c/N :!7 '14..1"; 4.t.' e•ea, ef.4 "**44 e ..it 1./11, 'ete;k6. "' n". le 'lc 4452 ....45C''.1 " ., :-- .... ,2 . fe, -, -:-.1. ,.1,7,1,4 irk' iv. e ,i4.. ;-. q .f. '• '•r4 S CS•F.e .4- ••••, ' -' -4 • . '‘' s.S•4-- 4e4" 4'4S4-Y 4.i.,.. . -,*f1111•46,4,0 44144 ...5 srf.e fr.- hkrtc." T. ,„„t.i, 4 St'e4 e ee, "K-- 0 •., .:.-44 ' " ,,,,,- '..r+or,rtirkt.,c A , ■,:i' 9:ig_,Di - .-x ,•. .,-,7,..7.105.7 , ce ' "• ' 4'447,7' •: i le ;% .-.4 ,,r•i 4 I: - .. ,,.•„•, , THIS HAS A BLUE P.ATTERNED,BACKGROUND SCIF10265(REV 2-01)