Laserfiche WebLink
POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-01-204 <br />COMMUNITY DEVELOPMENT AGENCY <br />ADMINISTRATIVE SERVICES DIVISION M -2S <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4OS8 <br />SG <br />GROUP; <br />POLICY NUMBER: 9023428 -2014 <br />CERTIFICATE ID: 9 <br />CERTIFICATE EXPIRES: 09 -01 -2015 <br />09-01-2014/09 - 01-2015 <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 />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 />Authorized Represontativo President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE,. <br />ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09- 01-2012 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PEOPLE FOR IRVINE COMMUNITY WEALTH (A SG <br />NON-PROFIT CORP.) ODA: 2 -1 -1 ORANGE COUNTY <br />1505 E 17TH ST STE 108 <br />SANTA ANA CA 92705 <br />[NMH,CS] <br />iREV.7.2e141 PRINTED : 03 -13 -2015 <br />!` Y <br />v <br />SG <br />