Laserfiche WebLink
CERTHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 9414270807 <br />COMPENSATION <br />IN SUFtANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07 -28 -2006 GROUP: 000046 <br />POLICY NUMBER: 0013230 -2006 <br />CERTIFICATE ID: 387 <br />CERTIFICATE EXPIRES: 05 -01 -2007 <br />05- 01-2008/05 -01 -2007 <br />CITY OF SANTA ANA <br />220 S DAISY AVE M -85 <br />SANTA ANA CA 92703 -4334 <br />SP UOB:SANTA ANA EMERGENCY WORK. <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 />This policy is not subject to cancellation by the Fund except upon30 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 <br />by the policy 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 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 />tTHCRIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05 -01 -2004 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PAULUS ENGINEERING, <br />INC. <br />2871 E CORONADO ST <br />ANAHEIM CA 92806 <br />(REV.2 -05) <br />INC. AND /OR R.F. PAULUS, <br />0 <br />[810,SGI <br />PRINTED : 07 -28 -2005 <br />SP <br />