Laserfiche WebLink
SK <br />CERTHOLDER COPY <br />STATE P.O. BOX 807 SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION'S <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 12-01-2003 GROUP: <br />POLICY NUMBER: 1270838-2003 <br />CERTIFICATE ID: 306 <br />CERTIFICATE EXPIRES: 12-01-2004 <br />12-01-2003/12-01-2004 <br />CITY OF SANTA ANA SK JOB: <br />PUBLIC WORKS AGENCY ATTN DAVID PATTON <br />20 CIVIC CTR PLZ M-21 ROSS ANNEX -FL 4 <br />SANTA ANA CA 92702 <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 policies 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 may pertain,,: the insurance afforded by the <br />policies described herein is subject to all. the terms, exclusions and <br />/Anconditions of such policies. <br />`yy' <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-2003:'IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br />F't ed(s`, bi "" TO "OR", <br />L. <br />pcputy City AtIo ney <br />EMPLOYER <br />....LEGAL NAME <br />HOUSTON & HARRIS PIPE CLEANING HOUSTON & HARRIS PCS INC <br />SPECIALISTS <br />21831 BARTON RD <br />GRAND TERRACE CA 92313 Alu <br />11-17-2003 .....,.., <br />