Laserfiche WebLink
• Aua-04-05 10:07 From-SAPD +714-245-8479 T-527 P.003/003 F-240 <br />CERTMOLOER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0607 <br />CNSUI1IA NICE <br />FM D CERTIFICATE OF WORKERS' COMPWSATION INSURANCE <br />ISSUE DATE: 06-03-2006 <br />CITY OF SANTA ANA SK <br />20 CIVIC CMZA PLAZA <br />SANTA ANA CA 92701 <br />GROUP: 000920 <br />POLICY NUMBER: 0000646-2004 <br />CERTIFICATE IO: 13 <br />CERTIFICATE EXPIRES: 12-31-200.1 <br />12-31-2004/12-31-2001i <br />This is to certify that we have iaaued a valid Workwe' Compensation Insurance policy In a form approvecl by the <br />California Insurance Commlanioner to the employer named below for IDs policy period indicated. <br />This policy In not subject to caneallauon by the Fwd except upon30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this pdiay be cancelled prior to its normal expiration. <br />This certificate of insurance is not an inaoranoo policy and does not amend, extend or alter the coverage afforded <br />by who policy lieled herein Netwithebndiny any requlremenS term or condi(tIQn of any contract or other document <br />with respect to which this certificate of insurance may DQ issued Or to vuhieh it may Dertsin. the insurance <br />afforded by the policy described herein Is subject to all the terms, exclusions. and conditicnc..doff auch policy. <br />A, ld�t,,,.z_ C . I� <br />AUTHORIZED R9PRC3ENTATIVC PRESEIENT <br />6TANDARD EXCLUSION: INDIVIDUAL CMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE <br />POR BENErITS AS EMPLOYEES UNDER THIS POLICY - <br />EMPLOYER'S LIABILITY LIMIT INCLUDINO OEPINSE COSTS, *1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2005 ENTETLED CERTIFICATE NOLDER3' NOTICE CFFECTIVE 01-04-2005 IS <br />ATTACHED To AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PARSONS, CHtZS AND PARSONS, BENEOETTA <br />6403 MAPLE PL <br />RANCHO CUCAMONGA CA 51790 <br />McV.z-Dei <br />E:3 <br />Re p1,r�i�f'..' <br />fe10,5K <br />PRINTED : DS-03-Itlios <br />Received Aug -03-00 14:12 Prom- To-SAPD Page gas <br />SK <br />