Laserfiche WebLink
CL OLDER COPY SP <br />STATE TATE P.O. BOX 807, SAN FRANCISCO,CA 94142 -0907 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-01 -2005 - GROUP: <br />POLICY NUMBER: 1528845 -2005 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES- 0,1-01-2006 <br />01 -01- 2.005/01 -01 -2006 <br />CITY OF SANTA ANA SP JOB: <br />COMMUNITY DEVELOPMENT AGENCY (M - ?S) <br />PO BOX 1988 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a. valid Workers',. Complin.,sition insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named HeoVikfor the policy period indicated.. - - <br />This policy is not subject to cancellation by the, Fund except upon 10 days' advance written notice -to the employer. <br />We will also give you 10 days' advance notice should th3tc 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 requirettTehL term, or condition of any .contract or other document <br />with respect to which this certificate of insurance may 4 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 />AUTHORIZED REPRESENTATIVE 'PRESIDENT. <br />.EMPLOYER'S LIABILITY LIMIT INCLUDING. DEFENSE COSTS: ^ $1,000,000:00 PER OCCURRENCE. <br />EMPLOYER ` <br />LEGAL NAME- <br />ORANGE COUNTY ON TRACK AMERICAN ON TRACK <br />PO BOX 4141 (A NON - PROFIT CORP) <br />TUSTIN CA 92781 <br />IREV.3 -03) PRINTED: 12/47/2004 PQ408 <br />