Laserfiche WebLink
WdUI~V '6 'a~W ew,l paniaaa~ <br />CERTMOLDER CORY sc <br />STATE p0 BOX 420A07, SAN FRANCISCO.CA 94142-Oa07 <br />COaaP'QNSATION <br />IN SURANCe <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-09-2007 GROUP; 000229 <br />POLICY NUMBER: 0023078-2007 <br />CERTIFICATE ID: tte <br />CERTIFICATE EXPIR65: Ot-01-2008 <br />O1-Ot-2007/01-01-2008 <br />CITY OF SANTA ANA THE DEPOT AT SANTA ANA 5G <br />7000E SANTA ANA BLVD <br />SANTA ANA CA 82701-3900 <br />This is tv certify that we have Iswed a valid Workers' Compensation Insurance policy in a farm approved by the <br />Colitornia Insurance C.ommieeinnar to the emDlOyar named below for the pDh Gy perl0d indl Cdted, <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this pvticy ba cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend ar alter the coverage aiiordetl <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this cerh}icate of insurance may be issued or to which it may pertain, the insurance <br />of icrdad by the nnllny dwenrihad herein is subject to all the terms. exclusions, and conditions. v} such pollcv. <br />THORIZED REPRESENTATI PRESIDENT <br />ENP LOYER'S LIABILITY LIMIT INCLUOINC DEFENSE COSTS: 51,000,000 PER OCCURRENCE. <br />ENDORSENENT M2066 ENTITLED CER7I F'ICA7E HOLDER5r NOTICE EFFECTIVE 01-01-2005 IS <br />ATTACHED TD AND FORNS A PART OF THIS POLICY. <br />,QAO <br />" - SSORCKneY <br />~\SA E ~tt`/ A~Ot <br />~SlStart ~~ <br />,J ~ <br />EMPLOYER <br />/OR TRI-COUNTY ORYYALL B <br />INTERIORS I C. <br />1992 N OATAVIA tiT STE 2 <br />ORANGE L'A 82867 <br />(B I O,SP] <br />Iaev.t•vsl PRINTED 03-08-2007 <br />