INFOSEND, INC. 1A -2008 - Laserfiche WebLink

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j; ~'' POLICYHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION FNSUFtANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-20-2009 GROUP: 000562 POLICY NUMBER: 0001424-2008 CERTIFICATE ID: 40 CERTIFICATE EXPIRES: 02-01-2010 02-01-2009/02-01-2010 CITY OF SANTA ANA gp ~~`~ PO BOX 1964 SANTA ANA CA 92702-1964 r a .. w 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. r':_.~- This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to th~~+~rployer.~"' ~D ~ We will also give you 30 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 EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - MAHMOOD REZAI,PRES,CEO - EXCLUDED. ENDORSEMENT #1600 - RUSTEEN REZAI, CEO - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-01-2008 IS ATTACHED TO AND FORMS APART OF THIS POLICY. gPPItO V ~i~ ~~ ~ ~:~ `~- Laura Stitt Shzeci;,~ Assistant City ~~~~~~~~~~~ EMPLOYER INFOSEND INC. 1041 S PLACENTIA AVE FULLERTON CA 92831 SP [JG8,CS] SP (REV.2-05) PRINTED : 04-20-2009