Laserfiche WebLink
SP <br />CE. .OLDER COPY <br />STATE P.O. BOX 807, SAN FRANCISCO,CA, 94142-68' 07 <br />CdMPENSATIClN: <br />N SU RAN CE <br />FU'N D CERTIFICATE OF WORKERS' COMPENSATION INWAANCE ' <br />ISSUE DATE: 01-01-2004 GROUP: <br />POLICY NUMBERS •t713776-2004 <br />":. CERTIF.ICATE ID;, 2 <br />CERTIFICATE ,PIRRS: 01-01-200$ <br />Ot-01•-.1004/01-01-2005 <br />G-i TY OF SANTA {NAS CD9G M-25 SP,% JOB,: ARE: GRANT FOR OEE,,NATAL H <br />COMMUNITY OEVEtOPMENT AG. NCY ' - & EtM1CATi0N PROdRAM <br />P=,O. 'BBX, 1988 M-2$=-' <br />SANTA WNA�,-GA :92702 . <br />This is to certify YKat we have issued a valid Worker ,t, Compensation insurance policy in.,(Firm approved by the •` <br />California;'jnturanc@ Commissioner tc, the employer'naenpd Gelb for the policyernod-indicate¢ <br />This policy is, not subject to'cancellationby the Fundoxcept ,upon 10daysS advance written notice to the employer. <br />`-- = We.•wili also give you 10 days"�,dvart6e notice thpuld,lhis policy be cancelled prior to ;its d'rmal`�expiration.: ` <br />This, cert?ficate af, insurance rja not un insurance policy and does hot amend. gXtend or alter the coverage afforded <br />by'the policies list herein N ithstanding any requirement,.. term, or c,oieditlore of ancontract,. or other document <br />with respect to which this certificate of insurance maY y pertain <br />be issued or may , the ryigs' !Jlica affordtid by the <br />. popcfes d8§csYb'edheC^gm is subject to all the terms, 9"�{gluspns and conditions, of such, policies., <br />Aj <br />AUTHORIZED REPRESENTATIVE: •7' PRESIDENT <br />`TN EMPCOYER.'S LIABILITY LIMIT INCLUDING DEFENSE COSTS;' $1,000,-000.00 ,PER OCCURRENCE. <br />s <br />� Y <br />• oil .. ... .v , 'r <br />r J a <br />i' <br />M s S <br />tf.'YS xI 4✓ t *Y� W k* ,. <br />ka5'{ry CCC2 _ <br />a'•` '4• .- �, �.ii .t fi txi 4 Jri,i• . <br />E <br />s •a EMPLOYER`S ' .ay�t ,t;t t;a� k r.• ' �" <br />, ' <br />• 4EG14`NAMEr <br />P <br />`CASA TERESACASA TERESA <br />123 W MOLE AVE 1 � " <br />Q00GE CA W66 = <br />.tleEy.3-.031 . -12-17-200300,408 <br />