Laserfiche WebLink
Z002 <br />12/1072007 11:20 FAA <br />POLICYHOLDER COPY <br />so <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />Ihi SU1%A 04 CG <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />POLICY NUMBER: 0327047-2007 <br />ISSUE DATE: 10-01-2007 GROUP; <br />CERTIFICATE ID: 10-01-2006 <br />CERTIFICATE EXPIRES: <br />10-01-2007/10-01-2006 <br />SG JOE:BRISTOL STREET WIDENING PROJECT <br />CITY OF SANTA ANA <br />PUBLICYORKS <br />CIVIC A14A CENTER 7011--400666 <br />This Is to certify Thai 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 />This oollcy is not subject to Cancellation by the Fund except 401 "120 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 doom not condition a o1 nany contract or athergdocumerted <br />by the policy listed herein. Notwithstanding any requirement.. e o pertain, the insurance <br />with respect to which Lhis certificate of insurance may be Issued or to which it may P <br />afforded by the policy described herein is subject to all the terms. exclusions. and conditions, of such policy. <br />Q " ? <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 41,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - JAMES K. CAIN, PRESIDENT - EXCLUDED. <br />ENDORSEMENT AND FORMS A LED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-1663 IS <br />?ATTACHEC #2 PART Of THIS POLICY. <br />X45.: <br />EMPLOYER <br />J a 0 INDUSTRIES, INC. AND/OR CAIN, JAMES K. <br />(AN IND.) <br />7611 SUZI LN <br />WESTMINSTER CA 62663 <br />PRINTED : 0E-17-2007 <br />M0410