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CAMBODIAN FAMILY, THE - 2007
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CAMBODIAN FAMILY, THE - 2007
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Last modified
10/21/2013 11:35:20 AM
Creation date
9/20/2007 4:55:21 PM
Metadata
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Template:
Contracts
Company Name
THE CAMBODIAN FAMILY
Contract #
A-2007-181
Agency
Community Development
Council Approval Date
7/16/2007
Expiration Date
6/30/2008
Insurance Exp Date
3/9/2008
Destruction Year
2012
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<br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />ru~~w.nu~u~~ ~~, <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 06-30-2007 <br /> <br />CITY OF SANTA ANA <br />PO BOX 1988 <br />SANTA ANA CA 92702 <br /> <br />GROUP: <br />POLICY NUMBER: 1696570-2007 <br />CERTIFICATE 10: 3 <br />CERTIFICATE EXPIRES: 06-30-2008 <br />06-30-2007/06-30-2008 <br /> <br />SC <br /> <br />This is to certify that we have issued a valid Work.ers' 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 10 days advance written notice to the employer. <br /> <br />We will also give you 10 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::::- REPRESENT ATl <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />EMPLOYER <br /> <br />THE CAMBODIAN FAMILY <br />1111 E WAKEHAM AVE STE E <br />SANTA ANA CA 92705 <br /> <br />~EV.2-05. <br /> <br />PRESIDENT <br />$1 , 000,000 PER OCCURRENCE. <br /> <br />;";..~j <br /> <br />~r.:.,<'~. <br /> <br />,,",?:";:-.-, <br /> <br />;~ ,-:.." {~, <br />.. . / <br /> <br />.~. <br /> <br />..~ ,,~ . .' <br /> <br />~'i~Y <br /> <br />j";." ....l...~:" .l.....' <br /> <br />SC <br /> <br />PRINTED <br /> <br />05-17-2007 <br /> <br />sc <br /> <br />M0409 <br /> <br />,I' <br />I/';) , jL \ <br />'----' <br /> <br />
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