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Paragon Partners 2
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READY TO DESTROY IN 2020
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Paragon Partners 2
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Last modified
3/25/2024 4:14:23 PM
Creation date
10/6/2005 9:06:50 AM
Metadata
Fields
Template:
Contracts
Company Name
Paragon Partners Ltd.
Contract #
A-2005-103
Agency
Public Works
Council Approval Date
5/16/2005
Insurance Exp Date
5/1/2008
Destruction Year
2020
Notes
Amended By A-2006-045
Document Relationships
Paragon Partners 2a
(Amended By)
Path:
\Contracts / Agreements\_PENDING FOLDER\READY TO DESTROY IN 2020
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STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 POLICYHOLDER COPY <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 06-22-2005 GROUP: <br />POLICY NUMBER: 1763833-2004 <br />CERTIFICATE ID: 128 <br />CERTIFICATE EXPIRES: 12-31-2005 <br />12-31-2004/12-31-2005 <br />CITY OF SANTA ANA <br />PUBLIC WORKS AGENCY <br />P O BOX 1988 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />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 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this 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 by the <br />policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy <br />described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />�0� <br />AUTHORIZED REPRESENTATIVE <br />kt,c.AL- <br />PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - NEILIA LAVALLE PRESIDENT - EXCLUDED. <br />ENDORSEMENT #1600 - JOEL SEWELL VICE PRESIDENT S,T - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-2004 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />APPROVED AS TO FORM <br />Laura Stitt hcedy <br />Assistant Ci Attornev <br />EMPLOYER <br />PARAGON PARTNERS, LTD <br />5762 BOLSA AVE STE 201 <br />HUNTINGTON BEACH CA 92649 <br />[BiO,SGI <br />SCIF 10262E Accept Nis certificate onl if PRINTED: W-22-2005 <br />P y you see elaint watermark that reads "OFFICIAL STATE FUND DOCUMENT' PAGE 1 OF <br />
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