Laserfiche WebLink
<br />SP <br /> <br />CERTHOLOER COpy <br /> <br />STATE <br />COMPliNSATION <br />INSURANCE <br />FUND <br /> <br />P.O. <br /> <br />807, SAN FRANCISCO,CA94142-.0aO7 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />THE CITY OF SANTA ANA <br />20 CiVIC CENTER PLAZA <br />SANTA ANA CA 92701 <br /> <br />SP <br /> <br />GROUP: <br />POLICY NUMBER: 1466943-2004 <br />CERTIFICATE 10: 14 <br />CERTIFiCATE,EXPIRES: 03-01-2005 <br />03"01-2004/03-01-2005 <br /> <br />JOB: ASBEStoS CONSUL TINa <br />SERVICES <br /> <br />ISSUE DATE: <br /> <br />03-01-2004 <br /> <br />N-;"o();1.- 0(,' <br />tJ - ~()O~ ":'/JII rd <br /> <br />This Is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California InslJr"9ce Commissioner to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. <br /> <br />We will also give you3Q daYs'adv"9ce notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificateof/ins~raqce is oot"n insurance policy and does not amend. extend or alter the øoverage $fforded <br />by the policies lI.~ted herein. NotwithsUind¡ng "9y requirement. term, or c9ndition of any contr;lct or .,ther . document <br />with resPect to which this certificate óf insurahce maye. issued or may pertain; the insurance afforded bY the <br />policies descrilted herein is subject to.allthe terms, ,,"clusions and conditions of such policies. <br /> <br />~ <br /> <br />,&~ t!. <br /> <br />&£- <br /> <br />AUTHQRIZEDREPRESENT A TIVE <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILIty LIMIT INCLUDING DEFENSE COSTS: <br /> <br />$1,000,000.00 <br /> <br />OCClIRRENCE. <br /> <br />. ENOORSEMENT#2OSS ENTITLED CERTIFICATE HOLDERS 'NOTICE EFFEctIVE 03~O1-2()04 IS <br />FO- A PARt OF THIS POLICY' . <br /> <br /> <br />AND <br /> <br /> <br />EMPLOYER <br /> <br />LEGAL .NAME <br /> <br /> <br /> <br />IREV.'-O'! <br /> <br /> <br />¡>til'r <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND scw 10260 <br /> <br />1'0408 <br />