Laserfiche WebLink
<br />NF <br /> <br />POLICYHOLDER COpy <br /> <br />STATE <br />COMPENSATIO.... <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 807, SAN FRANCISCQ,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 04-01-2003 <br /> <br />COUNTY OF ORANGE <br />HEALTH CARE AGENCY <br />515 WEST SYCAMORE <br />SANTA ANA CA 92701 <br /> <br />NF <br />CONTRACT SERVICES <br /> <br />GROUP: 000488 <br />POLICY NUMBER: 0000381-2003 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 04-01-2004 <br />04-01-2003/04-01-2004 <br /> <br />JOB: FILES NO EMPLOYEES <br /> <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 /> <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 you 30days'advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate ofinsufance is not an insurance policy and does not amend. extend or alter the coverage afforded <br />by the policies listed herein. Notwithstanding any requirE!:rnent, term, or condition of any contract or other document <br />with respect to which this certificate of insurance msy be issued or may pertaIn. the insursnce afforded by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. <br /> <br />p:~~ <br /> <br />~~t <br /> <br />&b- <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUOING OEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br /> <br />ENOORSEMENT #2065 ENTITLEO CERTIFICATE HOLOERS' NOTICE EFFECTIVE 04-01-2003 IS ATTACHEO TO ANO <br />FORMS A PART OF THIS POLICY. <br /> <br />\iED ASTU <br /> <br />~_._.. <br />.+----- . USA -C'~;-():"> <br />(',Ity /\: ,,'Ii <br /> <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />CALIF HISPANIC COMM ON ALCOHOL <br />AND DRUG ABUSE. lNC. <br />2101 CAPITOL AVE <br />SACRAMENTD CA 95816 <br /> <br />CALIFORNIA HISPANIC COMMI~ION ON <br />ALCOHOL ANO DRUG ABUSE, INC. <br />A NON-PROFIT CORPORATION <br /> <br />03-17-2003 <br />.:tlo:1l.I.Ie.t'I~lll:::l~..:"J..""''':l..I~:I''.II::t:I~I~II;J;:.'te3'~<ej:{.].J~I.~. 'l""iI=-fl1'~:1-"'I~ <br />