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01/14/2006 13:13 FAX 9516791329 Diamond/Ilichaels <br />CERTHOLDER COPY <br />ROTATE <br />MPENSATION <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142--0807 <br />INSURANCE <br />FUND <br />CERTIFICATE OF WORKERS' COMPENSATION <br />INSURANCE <br />ISSUE DATE: 01-14-2008 GROUP: <br />POLICY NUMBER 1860382-2007 <br />CERTIFICATE Ib: 1e <br />CERTIFICATE EXPIRES: 11-01-2008 <br />11-01-2007/11-01-2008 <br />WATER OEPARTMENT <br />CITY OF COLTON <br />650 N LA CADENA OR <br />COL,TON CA 82324-2823 <br />SG <br />This is o <br />Cnllfom aImuran ce Commiss onersttodthe emPloyerkenamed below forn <br />nthe policy Period !Indica erd approved by the <br />This p01lcy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This; certificate of Insurance is not In insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirementce may, term or condition of any contract or other dacument <br />t ordedpby the policy des ribedlcAta hereinfisnsurs subject to alSbthessued terms�exclushans,r to wichlandacondtlonsthoftnsurance such policy. <br />tT�70RIZSDREPRESENTATIVO PRESIDENT <br />E14PLOYERIS LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT y1®00 - CRAIG NEUSfA£OTER P,S,T - EXCLUDED. <br />ENDORSEMENT #2068 ENTITLEO CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-01-2007 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />ENDORSEMENT #2670 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2008-01-14 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: <br />WATER DEPARTMENT <br />EMPLOYER <br />TRANSPORTATION ENGINEERINQ & PLANNING, INC <br />14881 SUMAC AVE <br />IRVINE CA 0280e <br />[810.SPj <br />IREv.2-05i PRINTED : 01-14-2008 <br />laoowooc <br />SG <br />