Laserfiche WebLink
POLICYHOLDER COPY <br />SIP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-01-2021 <br />CITY OF SANTA ANA COMM. DEVELOPMENT AGENCY <br />20 CIVIC CENTER PL2 <br />SANTA ANA CA 92701-4058 <br />GROUP <br />POLICY NUMBER: 9023428-2021 <br />CERTIFICATE ID: 48 <br />CERTIFICATE EXPIRES: 09-01-2022 <br />09-01-2021/09-01-2022 <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 />This policy 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 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 <br />dbby� the <br />poo�lliic/cyy�described herein is subject to all the terms. exclusions, and conditions, of such policy. <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT M2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PEOPLE FOR IRVINE COMMUNITY HEALTH A SP <br />NON-PROFIT CORP. DBA: 2-1-1 ORANGE COUNTY <br />1505 E 17TH ST STE 108 <br />SANTA ANA CA 02705 <br />IREV.7-20141 <br />RiA Mn.g.1 Ni <br />ReaEwF.o& Arraw® ar: <br />R61tMmagemnt ClaialAitle <br />PRINTED : C <br />