Laserfiche WebLink
CERTHOLDER COPY <br />STATE SG <br />COMPENSATION P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-23-2008 GROUP: 000092 <br />POLICY NUMBER: 0000878-2007 <br />CERTIFICATE ID: 145 <br />CERTIFICATE EXPIRES: 01-01-2009 <br />01-01-2008/01-01-2009 <br />CITY OF SANTA ANA SG <br />ATTN.: DAVID IP <br />PO BOX 1988 <br />SANTA MIA CA 92702-1988 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />with <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document to which this affordedpbytthe policy described?he einfisnsub subject to alb he terms, exclusii1ons,'a daconditionsthofsuch pol <br />urance <br />1 <br />policy. <br />qa- <br />HORIZED REPRESENTATI CT' PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1800 - ROGER FRANK PRES - EXCLUDED. <br />ENDORSEMENT #1800 - ALAN FRANK S,T - EXCLUDED. <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />ITQ <br />go <br />Wool <br />?S?s<ar L ? l <br />EMPLOYER <br />JOHNSON-FRANC & ASSOCIATES (A CORP) SG <br />5150 E HUNTER AVE <br />ANAHEIM CA 92807 <br />[B10,SGI <br />(REV.2-05) PRINTED : 04-23-2008 <br />PDF created with pdfFactory Pro trial version WWW.Ddffactory com