Laserfiche WebLink
<br />. <br /> <br />.THOLDER COpy <br /> <br />SG <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />A _ ;:;..cc5-1 d- 1 <br />i+_Xj')5-11;) A <br /> <br />GROUP: <br />POLICY NUMBER: 0539588-2005 <br />CERTIFICATE ID, 199 <br />CERTIFICATE EXPIRES: 08-01-2006 <br />08-01-2005/08-01-2006 <br /> <br />ISSUE DATE: 11-01-2005 <br /> <br />CITY OF SANTA ANA <br />CLERK OF CITY COUNCIL <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />SG <br /> <br />uoB:12-1055 <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 norma! 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 policy listed herein. Notwithstandjn~ any reClu;rement, 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 />J~t <br /> <br />~ <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-01-1991 IS <br />ATTACHED TO ANO FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />BEINHAKER PLANNING & DEVELOPMENT AND SERVICES <br />INC. (PARTNER) AND NEAL A. IRWIN OF CALIFORNIA <br />INC (PARTNER) AND LAVALLE CONSULTANTS INC. <br />(PARTNERS) DBA: IBI GROUP <br />18401 VON KARMAN AVE STE 110 <br />IRVINE CA 92612 <br /> <br />{REV.2-05} <br /> <br />PRINTED <br /> <br />[RlI.CN] <br />11-01-2005 <br />