Laserfiche WebLink
<br />~... <br /> <br />CERTHOLDER COPY <br /> <br />STATE <br />COMPENSATION <br />IN SURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 09-30-2005 <br /> <br />CITY OF SANTA ANA <br /> <br />2 FARADAY <br />IRVINE CA 92618 <br /> <br />SC <br /> <br />GROUP: <br />POLICY NUMBER: 1717797-2004 <br />CERTIFICATE 10: 376 <br />CERTIFICATE EXPIRES: 11-01-2005 <br />11-01-2004/11-01-2005 <br />THIS CERTIFICATE SUPERSEDES AND CDRRECTS <br />CERTIFICATE 8 305 DATED 12-23-2004 <br />~06:NDRTHWEST CORNER OF SANTA ANA 6LVD <br />& ROSS ST., SANTA ANA, CA <br />(FILE NO. 18811) <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 that will expire or did <br />expire as indicated above. <br /> <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy 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 to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions. and conditions, of such policy. <br /> <br />~ <br /> <br />~~~ <br /> <br />~ <br /> <br />AUTHORIZED REPRESENT A TIVE PRESIDENT <br />EMPLOYER'S LIA6ILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 81600 - EDWARD F HILL PRESIDENT SECRETARY - EXCLUDED. <br />ENDORSEMENT 81800 - MICHAEL SAVAGE VICE PRESIDENT TREASURER - EXCLUDED. <br />ENDDRSEMENT 82065 ENTITLED CERTIFICATE HOLDERS' NDTICE EFFECTIVE 11-01-2003 IS <br />ATTACHED TO AND FDRMS A PART OF THIS POLICY. <br />ENDORSEMENT 82570 ENTITLED WAIVER DF SUBROGATION EFFECTIVE 2005-09-30 IS <br />_ ATTACHED TD AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: <br />CITY OF SANTA ANA <br /> <br />RECEIVED <br /> <br />EMPLOYER <br /> <br />GEDTECHNOLDGIES INC <br />439 WESTERN AVE <br />GLENDALE CA 91201 <br /> <br />SC <br /> <br />on Ii 5 }U1I5 <br />GOI1IJON & WILLIAMS <br /> <br /> <br />'--L-,' <br /> <br />if) <br /> <br /> <br />(REV.2-0S) <br /> <br />'---~~CdY ------- <br /> <br />Assistant City Atlorn\.~\ <br /> <br />[B19.SC] <br />PRINTED 09-30-2005 <br />