OMEGA GROUP, THE 2 - 2003 - Laserfiche WebLink

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so CERTHOLDER COPY STATE P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE FU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-01-2004 GROUP: POLICY NUMBER: 1302649-2004 CERTIFICATE 10: 29 CERTIFICATE EXPIRES: 10-01-2005 10-01-2004/10-01-2005 SANTA ANA POLICE DEPARTMENT ATTN 8RIAN SHELOON 60 CIVIC CENTER PLAZA SANTA ANA CA 92702-6956 SO This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term. or condition of any contract or other document with respect to which this certificate of insurance maybe issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms.exdusions and conditions of such policies. ~ ~~C &L AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUOING DEFENSE COSTS: $1 ,000, OQO. 00 PER OCCURRENCE. ENODRSEMENT #2065 ENTITLED CERTIFICATE HDLOERS' NOTICE EFFECTIVE 10-01-2004 IS ATTACHEO TO ANO FORMS A PART OF THIS POLICY. ~:V' EMPLOYER LEGAL NAME THE OMEGA GROUP, I NC 5160 CARROLL CANYON RO FL 1 SAN OIEGO CA 92121 THE OMEGA GROUP, INC IREV.3.03) PRINTED: 09/17/2004 .. . :' . . .