CAMBODIAN FAMILY, THE - 2007 - Laserfiche WebLink

Home Browse Search

STATE COMPENSATION INSURANCE FUND ru~~w.nu~u~~ ~~, P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-30-2007 CITY OF SANTA ANA PO BOX 1988 SANTA ANA CA 92702 GROUP: POLICY NUMBER: 1696570-2007 CERTIFICATE 10: 3 CERTIFICATE EXPIRES: 06-30-2008 06-30-2007/06-30-2008 SC This is to certify that we have issued a valid Work.ers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement. term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain. the insurance afforded by the policy described herein is subject to all the terms. exclusions. and conditions. of such policy. a::::- REPRESENT ATl EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: ~ EMPLOYER THE CAMBODIAN FAMILY 1111 E WAKEHAM AVE STE E SANTA ANA CA 92705 ~EV.2-05. PRESIDENT $1 , 000,000 PER OCCURRENCE. ;";..~j ~r.:.,<'~. ,,",?:";:-.-, ;~ ,-:.." {~, .. . / .~. ..~ ,,~ . .' ~'i~Y j";." ....l...~:" .l.....' SC PRINTED 05-17-2007 sc M0409 ,I' I/';) , jL \ '----'