Laserfiche WebLink
POLICYHOLDER COPY SP <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 <br />COMPENSATION <br />114 SURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08 -23 -2007 GROUP: 000481 <br />POLICY NUMBER: 0000413 -2006 <br />/V , rR 00 7_0 p4 CERTIFICATE EXPIRES: CERTIFICATE 41 <br />0 O8"23 -2008 <br />08- 23- 2007/08 -23 -2008 <br />CITY OF SANTA ANA SP <br />DEPARTMENT OF PUBLIC WORKS <br />20 CIVIC CENTER PLAZA #M -21 <br />SANTA ANA CA 92702 <br />This is to certify that we have issued a valid Worker s'gzEompensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for. the policya.period indicated. <br />This policy is not subject to cancellation by the Fund sUcept upon 30 days advance written notice to the employer. <br />We wily also give you 30 days advance - notice: should this policy- be.:cancalled prior to its -normal- expiration , <br />This certificate of insurance is not an .insurance policy rind does not amend,..extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requiremlent, term or condition of any contract or other document <br />with respect to which this certificate of insurance mayfbe 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. a <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSS. COSTS: $1,000,000 PER OCCURRENCE. ; <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08 -23 -2006 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />CURBSIDE, INC SP <br />1160 N ARMANDO ST <br />ANAHEIM CA 92808 <br />M0410 <br />IREV.2 -05i PRINTED : 07 -17 -2007 <br />