Laserfiche WebLink
<br />AUG-17-200d 11:d7 <br /> <br />SPECTRUM RISK MGMT <br /> <br />P.0d/0d <br /> <br />. <br /> <br />STATE po. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />C:OM...NSATION <br />INSUR......U;;e <br />FU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />tSSUI alT.. 08-17-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 1750075-2004 <br />CERTIFICATE 10; 106 <br />CERTIFICATE EXPIRES: 07-01-2005 <br />07_01_2004/07-01-200' <br /> <br />C:ITY OJ' 1I11l'1'A M& <br />::aO C:rvxC currBll 1'LACB <br />11'.0. BOX 1988 <br />PlIlTA M& CA9270::a <br /> <br />This Is to certify that we have iSSUed a valid Worker's COmplnUdon ineurance policy in a lonn approved ~y the California <br />In5llrance Commissioner to the employer named below lor the policy period IndlCQted. <br /> <br />This pOlicy is not $U~ject to cancellation by thll Fund Illcepl upon 30 da~ allvllnce written.nollceJo the employer. <br /> <br />We will also give you 30 days advance notice should th.ls poliCy be cancaJled, priOrtons nOnnal, expiration. <br /> <br />this certllicale 01 insurance is not an insurance poliCY and does not amend. extend .or alter the coverage afforded by the <br />policy listed he,ein.lIlolWilh614ndlngany requirernElllt;te(ITIOl' condition gf anycontreclor olI1erdocument with <br />respect to which lhisceltilicata of insurance may be ISSUlild or t!' which ilmay pertllln, the Insurance afforded ~y the policy <br />describod herein is subject to alllhe.tenne, exc:lusion&; and conditions. 01 stiCh 'pollcy'; <br /> <br />~ <br /> <br />AUTHORIZED AEPAESEW'ATIVE <br /> <br />A;d_ ~ c. fJL. <br /> <br />PAEGlDENT <br /> <br />IDIl'LOYIIR' S LUB:ILITY LDUT %HCLUIlDIC DIII'IIIlISB COSTS I $1. 000 , 000 PBa OCCll1UlElllCB. <br /> <br />BIIlIOas~ 11600 - IWlGMBT PAl'PARll, PIlBs:m1DlT III11CRZ'1'BY ... at:LtmlW. <br /> <br />BIIDORaBIID1'1' 111600 - nAIJIt PAl'lI'lIJIO, nCB II'USIDDI'1' - BXCLUlIlIIl. <br /> <br />:amoRSEIIIIBR'1' 12065 BIII'1'I'1'LllID CU'1'IP:l:CA'1'II HOLDBlIS' HO'l':IeJl BJ'J'I!lCTJ:VB 07-01.2003 J:S <br />A'1"1'ACIIIID '1'0 AIm I'ORMS A PART OJ' 'l'BJ:S POLICY. <br /> <br />~~~ <br /> <br />EWPLOYeA <br /> <br />'1'S05 COD <br />19281 GOTBaRD8T S'1'II. 109 <br />HURT:I~ aca CA '25.B <br />