CARD METERING SYSTEMS 1 - Laserfiche WebLink

Home Browse Search

CERTHOLDER COpy S.J STATE COMPENSATION INSUFlANCE FUND P.o. BOX 420807, SAN FRANCISCO,CA 94142-0807 A. ;;)UL'i-f -,;)!;;L CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-01-2008 GROUP: 000560 POLICY NUMBER; 0000371-2008 CERTIFICATE 10: 20 CERTIFICATE EXPIRES: 10-01-2009 10-01-2008/10-01-2009 CITY OF SANTA ANA CLERK OF THE CITY COUNCIL 20 CIVIC CENTER PLAZA (M-30) SANTA ANA CA 92704 S.J This is to certify that We have issued a valid Workers' Compensation insurance pOlicy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions. of such policy. d::REPRESENTATI EMPLOYER'S LIABILITY LIMIT ~~ PRESIDENT INCLUDING DEFENSE COSTS: $1.000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2005 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. - - - EMPLOYER CARD METER SYSTEMS INC DBA: C M S INC S.J PO BOX 8344 TUCSON AZ 85738 (REV.2-0S) PRINTED 09-17-2008 M0408