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<br />r-- <br /> <br />")-1 <br /> <br />, <br /> <br />. <br /> <br />411fERTHOLDER COPY <br /> <br />SK <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br /> <br />"-j <br /> <br />, ~,,~,""".. <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 30 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 <br />by the policies listed herein. Notwithstanding any requir~ment. term, or condition of any contract or other document <br />with respect to which this certificate 01' insurance may be .issued or may pertain, the insurance afforded by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. <br /> <br />~ <br /> <br />~~c <br /> <br />~ <br /> <br />AUTHORIZED REPRESENT A TIVE PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUOING OEFENSE COSTS: $1,000.000.00 PER OCCURRENCE. <br /> <br />ENOORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2004 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br /> <br />~nnd-u. . ... <br />f~_W: -:.1. <br /> <br />,..)(,[;-,::, <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />KINKLE. ROOIGER, AND SPRIGGS <br />3333 14TH ST # 200 <br />RIVERSIOE CA 92501 <br /> <br />KINKLE, ROOI~ER. ANO SPRIGGS <br />(A PROF. CORP.) <br /> <br />fWd- <br /> <br />