Laserfiche WebLink
CE; :;OLDER <br />COPY <br />STATE <br />P.O. BOX <br />807, SAN FRANCISCO,CA <br />94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUN <br />CERTIFICATE <br />OF WORKERS' <br />COMPENSATION INSURANCE <br />ISSUE DATE: 02-01-2004 <br />GROUP: <br />000488 <br />POLICY NUMBER: <br />0000626-2003 <br />CERTIFICATE ID: <br />5 <br />CERTIFICATE EXPIRES: <br />02-01-2005 <br />02-01-2004/02-01-2005 <br />CITY OF SANTA ANA CDBG M-25 <br />SP JOB: RE: <br />FUNDING <br />COMMUNITY DEVELOPMENT <br />AGENCY <br />P.O. BOX 1988 M-25 <br />SANTA ANA, CA 92702 <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 />This policy is not subject to cancellation by the Fund except upon 10days' advance written notice to the employer. <br />We will also give you lO days' advance notice should this policy be cancelled prior to its normal expiration <br />This certificate of. insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policies.: listed herein. Notwithstanding any requirement, term, or condition of any contract co other document <br />with respect. to which this certificate of insurance maybe issued or may pert :the insurance afforded, by the <br />Policies described herein is subject to all the terms, exclusions and conditions of such policies. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYERS. LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br />EMPLOYER <br />TEEN CHALLENGE OF SO CA , INC <br />PO BOX 5039 <br />RIVERSIDE CA 92517 <br />LEGAL NAME <br />TEAN CHALLENGE OF SO CA INC <br />IRev.3-01 TPRINTED: 01 17-2004 P0408 <br />•R7P11'R' <br />