Laserfiche WebLink
<br />SG <br /> <br />CERTKOLDER COpy <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 04-02-2005 <br /> <br />GROUP: <br />POLICY NUMBER: 1695562 -2005 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EX~IRES: 04-02-2006 <br />04-02-2005/04-02-2006 <br /> <br />CITY OF SANTA ANA <br />ATTN MARY CHIECHI <br />20 CIVIC CTR PLAZA RM M-97 <br />SANTA ANA CA 92701 <br /> <br />SG <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 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 sub iect to all the terms, exclusions and conditions of such policies. <br /> <br />~ <br /> <br />A~t <br /> <br />&L <br /> <br />AUTKORIZED REPRESENTATIVE PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-02-2005 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />LEGAL NAME <br /> <br />( <br />\ <br /> <br />PROPERTYBUREAU COM <br />3551 CAMINO MIRA ~OSTA <br />SAN CLEMENTE CA 92672 <br /> <br />PROPERTY BUREAU COM INC <br /> <br />THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF ",,, <br /> <br />(RE.V.3-031 <br /> <br />PRINTED: 03/17/2005 PQ408 <br />