Laserfiche WebLink
THOLDER COPY <br />SP <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br />P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-01-2005 <br />GROUP: 000488 <br />POLICY NUMBER: 0000562-2005 <br />CERTIFICATE ID: 5 <br />CERTIFICATE EXPIRES: 04-01-2006 <br />04-01-2005/04-01-2006 <br />CITY OF SANTA ANA SP <br />COMM. DEVELOPMENT AGENCY M-25 <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <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 />This policy is not subject to cancellation by the Fund except upon 10days' advance written notice to the employer. <br />we wilt.. also give you 10 days' advance notice shouldthis policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and -does not amends extend or alter the coverage afforded <br />by thepolicies 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 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 />NPPA0VkD AS TO FORM <br />e <br />Larva Stitt <br />Assistant City Atidy <br />ttornev <br />EMPLOYER <br />HUMAN OPTIONS <br />MARY ALDERSON <br />Po BOX 53745 <br />IRVINE CA 92619 <br />.LEGAL NAME <br />HUMAN OPTIONS <br />PRINTED:03/17/2005 .00G <br />THIS DOCUMENT -WAS A BLUE PATTERNED BACKGROUND Spf 10265 <br />