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DELHI CENTER - 2004 FEZ
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DELHI CENTER - 2004 FEZ
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Entry Properties
Last modified
4/16/2013 3:39:59 PM
Creation date
11/24/2004 9:08:43 AM
Metadata
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Template:
Contracts
Company Name
Delhi Center
Contract #
A-2004-161
Agency
Community Development
Council Approval Date
8/2/2004
Expiration Date
6/30/2005
Insurance Exp Date
12/14/2005
Destruction Year
2010
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<br />CERTHOLDER COPY <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMFi'ENSATION <br />INSURANCE <br /> <br />FU NO CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 07-09-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 1528709-2003 <br />CERTIFICATE ID: 18 <br />CERTIFICATE EXPIRES: 11-01-2004 <br />11-Ol~2003/11-01-2004 <br /> <br />SANTA ANA WORK CENTER <br />1000 E SANTA ANA BLVD <br />SANTA ANA CA 92701 <br /> <br />STE 200 <br /> <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />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 10 days advance written notice to the employer. <br /> <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the <br />policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br />described herein is subject to all the terms, exclusions, and conditions, of such policies. <br /> <br />~ <br /> <br />4~c <br /> <br />&L <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE. <br /> <br />~sh- <br /> <br />EMPLOYER <br /> <br />DELHI CENTER (NON-PROFIT CORPORATION) <br />505 E CENTRAL AVE <br />SANTA ANA CA 92707 <br /> <br />SCIF 10262E <br /> <br />Accept this certifIcate only if you see a faint watermark that reads "OFFICIAL STATE FUND DOCUMENT" <br /> <br />[LDH,SP] <br />PRINTED: 07-09-2004 <br />PAGE 1 OF 1 <br />
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