Laserfiche WebLink
POLICYHOLDER COPY <br />P.D, BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS` COMPENSATION INSURANCE <br />ISSUE DATE: 00-01-2021 <br />CITY of SANTA ANA COMM. DEVELOPMENT AGENCY <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-40SS <br />GROUP: <br />POLICY NUMBER. 9023428-2021 <br />CERTIFICATE 117: 48 <br />CERTIFICATE EXPIRES: 0-01-2022 <br />09-01-2021/08-01-2022 <br />This is to certity that we have issued a valid Worke'rs' Compensation insurance policy in a form approved by 1he <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 r406ce 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 after the coverage afforded <br />by, the policy listed here4i 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 />Authorized i4epresentative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE CASTS: $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT N2M ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012 IS <br />ATTACHED TO ANP FORMS A PART OF THIS POLICY, <br />EMPLOYER <br />PEOPLE FOR IRYINE COMMUNITY HEALTH A SP <br />NON-PROFIT CORP, ORA, 2-1-1 ORANGE COUNTY <br />1505 E 17TH ST STE 108 <br />SANTA ANA CA 92705 <br />ME M- 24141 <br />It <br />�,��..�.�� �tlsk �(tii�C4et �: <br />��(���i`�(j tt'Ev ID7m�f�ewtn m8 <br />,IEllJif 1'.1"IcS2L <br />plskManagemav 0-1.1 lade -- <br />PRINTED 0__- <br />