Laserfiche WebLink
FEB. -24' 04 (TUE) 09:23 TEL:714 373 1234 P. 002/003 <br />POLICYHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMMl N6ATION <br />IN S U R A N C E <br />PUN© CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />JANUARY 22. 2004 <br />CITY OF SNATA ANA <br />DEPARTMENT OF PUBLIC WORKS <br />P 0 BOX 1908 <br />SATNA ANA CA 92702 <br />GROUP: <br />POLICY NUMBER: 3.763033-2001 <br />CPRTIFICATE ID: 55 <br />CERTIFICATE EXPIRES: 12-11-2004 <br />12-31-2003/12-31.2004 <br />A - a7oo3 - oa 9 <br />This is to certify that we have Issued a valid Worker's Compenaation insurance ollcy In a form approved by the California <br />Insurance Commissioner to the employer named below for the policy period Ind Gated, <br />This policy is not subject to cencellallon by the Fund except upon 10 days advance written notice to the employer. <br />We will also give you 10 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 />policies 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 may parrdin, the Insurance afforded by the policies <br />described hareln Is subject to all the terms. exeluaiens, and conditions, of such policies. <br />AIITHOAZED REPIIE5ENTATR2 <br />A'4e, e.� <br />rms oer r <br />EMPLOYER'S LIABILITY LTMTT INCLUDING DEFENSE COSTS: 91,000,000 PER OCCURRENCE <br />EMPLOYEe <br />PARAGON PARTNERS, LTD <br />5762 SOLER AVS, 4201 <br />HUNTINGTON BEACH CA 92649 <br />SCIF 70292E r6PPdll; NO 1 <br />