Laserfiche WebLink
<br />CERTHOLDER COpy <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 />ISSUE DATE: 02-01-2007 <br /> <br />GROUP: 000488 <br />POLICY NUMBER: OOOD626-2006 <br />CERTIFICATE 10: 5 <br />CERTIFICATE EXPIRES: 02-01-2008 <br />02-01-2007/02-01-2008 <br /> <br />CITY OF SANTA ANA CD6G M-25 <br />COMMUNITY DEVELOPMENT AGENCY <br />P.O. 60X 1988 M-25 <br />SANTA ANA, CA 92702 <br /> <br />SP <br /> <br /><lOB:RE: FUNDING <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 normal 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. 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 /> <br />a::::REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUOING OEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />$1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLEO CERTIFICATE HOLOERS' NOTICE EFFECTIVE 02-01-2005 IS <br />ATTACHEO TO ANO FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br /> <br />TEEN CHALLENGE OF SO CA , INC <br />5445 CHICAGO AVE <br />RIVERSIOE CA 92507 <br /> <br />SP <br /> <br />(REV.2.05) <br /> <br />PRINTED <br /> <br />01-19-2007 <br /> <br />~ <br /> <br />SP <br /> <br />M0408 <br />