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CERTIFICATE OF INSURANCE <br />issued by the <br />STATE COMPENSATION INSURANCE AUTHORITY <br />950 BROADWAY, DENVER, COLORADO 80203, (303) 837-4000 <br />222 SOUTH 6TH STREET, SUITE 404 (303) 248-7335 <br />GRAND JUNCTION, CO BZSOZ FAX -243-2607 <br />TO WHOM IT MAY CONCERN: <br />This is to Certify that this company has issued a Standard Workmen's Compensation and Employer's <br />Liability Policy as described below covering the Iiabiiity imposed upon subject employers by the <br />Workmen's Compensation Act of Colorado, said policy being in good standing as of this date. <br />POLICY NUMBER: 138911-2 JULY 2, 1990 <br />POLICY PERIOD: JULY 1, 1990 TO <br />INSURED: h10UNTAIN REGION CJRP <br />174 - 31 ROAD <br />~. GRAND JUNCTION, Cif 81501 <br />QUARTERLY ADJUSTMENTS <br />DATE OF ORIGINAL ISSUE: 6-19-82 <br />CO CHARLES DUCRAY COVERED 8810 <br />CO KENT DUCRAY.CUVERED 6217 <br />CU SANDRA DUCRAY COVERED 8810 <br />JULY 1, 1991 <br />' ** FOR ADDITIONAL COPIES, THIS CERTIFICATE MAY BE REPRODUCED. ** <br />IMPORTANT: THE COVERAGE DESCRIBED ABOVE IS IN EFFECT AS OF THE ISSUE DATE OF THIS <br />CERTIFICATE. IT IS SUBJECT TO CHANGE AT ANY TIME IN THE FUTURE. <br />All policies are subject to the following provision of the Workmen's Compensation Act with <br />respect to cancellation: <br />Section 8-54-114. If any employer shall be in arrears for more than thirty days in any payment required to <br />be made by him to the State Compensation Insurance Authority as provided by this Act, he shall by virtue <br />of such arrangement be in default of such payment and any policy issued to him by said Authority shall <br />thereupon be cancelled without notice as of the effective date or renewal date of said policy. <br />STATE COMPENSATION INSURANCE AUTHORITY <br />FORM P-267 (6-68) ~/7~ ~/ <br />