Laserfiche WebLink
<br />.' I:1FtR ,_05 200'1 10, 2SAM HP lASERJET 3200 <br />_~133/200'!-.15: 11 STATE C!J>FENSATlCI'I .. 913103702474 <br /> <br />J <br /> <br />NO. ??9 <br /> <br />p.5 <br />IiIœ2 <br /> <br />--.; <br />POLICYHOLDER COP~ <br /> <br />í <br />I, <br />Ii <br /> <br />STATE P.O BOX 420807. SAN FRANCISCO, CA 94'42.0807 <br />"O"~E"'ATIO" <br />INgURA"Ç. <br /> <br />FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />I~~UE DATE, 02-03-2004 <br /> <br />GROUP: <br />POLICY NUIABEI!' 1519354-200' <br />CERTIFICATE 10, 107 <br />CERTIFICATE alCPJRes' 01-01-¡005 <br />01- 01- 2004/01-01-200 S <br /> <br />CITY OF SAJII'rA ABA <br />RISK MAMAGEMJ!NT <br />POBOX 1931 M-2S <br />SANTI'. ANA CA 92'702 <br /> <br />TIlls" \0 Clfti!y thlt we _lo...eeI. voli~ Wo_. Compensation in&llra""" polq In . form "¡>proved by tho CoIIfc<ni. <br />Insu...... Ccmmllllllo"'r 10 th, 0II1 )1oy'" n.med below ro, tho policy Þflliod IndIC8led. ' <br />Thlo pOlicy is not...bjec:t lo,canosllstlon by'" Fund ..oept upon 3ð dlys eduancewrltlen notIce to the employer. <br />We will also give y<>w 30 ~O\"'lICIvente I10Il... IIhollid this policy be oancolllld,priðrto lIS no"nal..pi..tion. <br />ThIs OOIIlfall! of In.""n"" Is not III Insuranc:e pokey 8n~ does nol8men~, .tend or ;lI8r tho COY8..ge .f!on eG by the <br />pOIlcieslisteG horoln. IoIolwIthll8ndil\g eny ,....itomert "'nil or canditJon 01 ""' contraot Of, otIer dQCUf!\l nt wttn <br />"'8 M!o\ 10 which tills OOIIltQato 01 ins...nce may be i88\lOd or may pettojn. tho lM.ranee alforQIId by 111. policies <br />Gooclibod he",ln Is SYb ed to aM 1II...rmo, """luIions,1IId CMIIltlon&. oIlNcII pofi~.., <br /> <br />~ <br /> <br />...-.."'...- <br /> <br />,ð~ C. ~ <br /> <br />,",,"DIN' <br /> <br />EtlPI.OYER.'S I.IABILITY LIIIIIT IHCLUDDIG DtP1!NSE COSTS, $1,000,000 PEl!. OCCURRBNCI!. <br /> <br /> <br />Ell\)ORS- tUDD - BRAIH P DALE, P, S, T - EXCI.UÐED. <br /> <br />iNl>ORSEM1!Ji\T U065 ENTtTI..ED C1I:ItTIPICATE HOLDERS' NOTICB EFFECTIVE 01-Ol-200t IS <br />ATTACIIED 'I'Q ANa FORMs A PARr 01 THIS l'OI.IC'l. <br /> <br />d6~.." <br />{fr <br /> <br />..,,"".. <br /> <br />RYGI8NE TEClittOLDGI1is mTEaIIAT¡ONAL. 1>0(:. <br />3525 DEL lIMO, BLVD SIB ¡eo <br />TORAANCI! CA 90503 <br /> <br />..--- -<---,_. ......._",...~.......",....".......oooc.....,.. <br /> <br />~r.'- <br />