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<br /> <br />. <br /> <br />411fERTHOLDER COPY <br /> <br />SK <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. sox 807, SAN FRANCISCO,CA 94142-0807 <br /> <br />~""'''''.*, , <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 01-01-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 0409627 -2004 <br />CERTIFICATE ID: 19 <br />CERTIFICATE EXPIRES: 01-01-2005 <br />01-01-2004/01-01-2005 <br /> <br />CITY OF SANTA ANA <br />ATTN CITY ATTORNEY <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br /> <br />SK <br />JOSEPH W FLETCHER <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. <br /> <br />We will also give you 30days'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 <br />by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document <br />with respect to which this certificate of insurance may be Issued or may pertain, the insurance afforded by the <br />policies described herein is subject to alJ the terms. exclusions and conditions of such policies. <br /> <br />~ <br /> <br />,d~ {! <br /> <br />~ <br /> <br />AUTHORIZED REPRESENT A TIVE PRESIDENT <br /> <br />EMPLOYER'S LIA6ILITY LIMIT INCLUDING DEFENSE COSTS: $1,000.000.00 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2004 IS AT]'ACHED TO AND <br />FORMS A PART OF THIS POLICY. <br /> <br />~...Jy <br /> <br />\ '}:;.i:~'..l <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />KINKLE, ROOIG~R; AND SPRIGGS <br />3333 14TH ST # 200 <br />RIVERSIOE CA 92501 <br /> <br />KINKLE, ROOIGER, AND SPRIGGS <br />(A PROF. CORP.) <br /> <br />;w ;}- <br /> <br />