Laserfiche WebLink
<br />11/12/2~~4 <br /> <br />12:~9 <br /> <br />NO. 6135 [;)13132 <br /> <br />. ~ ; . <br />~ t t !i: ' <br /> <br />CERTHOLOER COPY <br /> <br />STATE <br /> <br />1',0_ BOX 4201;107, SAN FRANCISCO, CA ~ 142-01;107 <br /> <br />COMifCN5ATIOI'll <br />INSURANCE <br /> <br />FU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br /> <br />ISSUB DATS, 11-12-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 1515871-2004 <br />C5RT1FICA TE ID: 16 <br />CERTIFICATE EXPIRIOS: 04-01-MO. <br />D4-0~-3004/o4-01~2005 <br /> <br />CI'1'l1 01' SlIJITA AHA <br />P~!C WOkXs AGENCY M-36 <br />PO BOX 1988 <br />SJ\lIITA ANA CA 92702 <br /> <br />JOS: AT'l'H: JOE PARCO <br /> <br />,-".; <br /> <br />This is to eertify tnat w, h.1I9 i$$VS<l. v.lid Worksrs Compsn811tlon Insvrant;Q polioy in a form approvsd by ths California <br />IMuranee Commi$$ioner to tn, ,,,,ploysr nam8d below for ths polioy psriod indi~atQd, <br /> <br />This pOlicy is n,OI .ubje'" 10 cancellation by the Fund except upon 30 d.ys adv,,",,,, written notice to the e"'ploy... <br /> <br />We will also give you 30 days ad""nca notice sIlould this policy be cancelled prior to its normalexpi"'Uon. <br /> <br />This certifieateof insuronca I. not an insuran"" pOlicy and doe. not amend, extend or aller the coverage afforded by the <br />policy listed h.rein. Notwlihstending any requiremen~ term or condition of any contract or other dooument with <br />re8P'c;t to which this certilicate or insurance may be issued or to which it may pertain, the insumnce affcrded by the policy <br />de...ribed herein is subjecl to all the terms, exclusions, and conditions, of such policy, <br /> <br />It <br />11.11 <br /> <br />~ <br /> <br />..&~ C. OL. <br /> <br />ALJTMORlZEO REPReSeNTATIVe <br /> <br />fl'RfSJDENT <br /> <br />BKPLOYBR'S LIABILITY L!MIT !KCLnn!KG DBPBKSB COSTS. $1,000,000 ~~ OCC~k!Ncg. <br /> <br />1llID0RSEm:NT U600 . ROGEIt FAUBEL. PRS, SC, TR - EXCLnnBD. <br /> <br />ENDORSEMBNT 'JOSS BNTITLKD C2RTIPICATB HOLDERS' NOTIC2 2FFE~rvB 04-01-2004 IS <br />AT'l'ACllEIl TO AND FORMS A PART OF TIlIS POLICY. <br /> <br />I'i <br />,ill! <br /> <br />:t I <br /> <br />~ufy <br /> <br />!EMPLOYER <br /> <br />I <br />I <br />i <br />I <br /> <br />_i <br /> <br />ROGEIt FAUBEL PUBLiC AFFAIItS <br />J5 OIlClIAJW <br />LAXE FORllST CA 9J630 <br /> <br />iRe DBA, WATERS . FAUBEL <br /> <br />~~'t'.-'t2020lM <br />