GRUVER, ERIC 9 - 2016 - Laserfiche WebLink

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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GROUP: ISSUE DATE: 12-01-2008 ' % POLICY NUMBER: 1675014-2008 )OVn , 0 3 CERTIFICATE ID: 1 IBJ I CERTIFICATE EXPIRES: 12-01-2009 z�iLf3 17(0 12-01-2008/12-01-2009 CITY OF SANTA ANA SP 80 CIVIC CENTER PLZ SANTA ANA CA 92701-4060 This is to certify that we have issued a valid Workers' 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. THORIZED REPRESENTATI PRESIDENT UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES CALIFORNIACWORKERS' OVERED NCOMPENSATION SBENEFITS; EMPLOYEES IVE PERSONAL I EXCLUDED TY AUNDERCE OCALIFORNLICY ICALIFORNIA COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $7,000,000 PER OCCURRENCE. i EMPLOYER GRUVER, ERIC PH D SP 17772 17TH ST STE 106 TUSTIN CA 92780 PRINTED : 11-17-2008 IREV.2-051 SP M0408