Laserfiche WebLink
POLICYHOLDER COPY SP <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSUMANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08-23-2007 GROUP: 000481 <br />�l r� j�/b POLICY NUMBER: 0000413-2008 <br />Al,CERTIFICATE ID: 1 <br />cRQV / -0 VCERTIFICATE EXPIRES: 08423-2008 <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 82702 <br />This is to certify that we have issued a valid Work or s'rgompensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for. the policynperiod indicated. <br />This policy is not subject to cancellation by the Fund ebtcept upon 30 days advance written notice to the employer. <br />We wily also give you 30 days advance-notica:-should ibis Policy- be.:cancalled 'prior to its -normal expirationAl <br />This certificate of insurance is not an .insurance policy aynd does not amend, -.extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requiremhnt, term or condition of any contract or other document <br />with respect to which this certificate of insurance maycbe 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 />tTHORIZED 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 I5 <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EWLOYER <br />CURBSIDE, INC SP <br />1160 N ARMANDO ST <br />ANAHEIM CA 92808 <br />M0410 <br />IREV.2-051 PRINTED 07-17-2007 <br />