My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
ENGINEERING SOLUTIONS SERVICES (2)-2017
Clerk
>
Contracts / Agreements
>
E
>
ENGINEERING SOLUTIONS SERVICES (2)-2017
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/25/2019 12:18:42 PM
Creation date
11/20/2017 11:14:21 AM
Metadata
Fields
Template:
Contracts
Company Name
ENGINEERING SOLUTIONS SERVICES
Contract #
A-2017-224
Agency
PUBLIC WORKS
Council Approval Date
8/15/2017
Expiration Date
8/14/2020
Insurance Exp Date
8/19/2020
Destruction Year
2025
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
51
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
EXTENSION OF THE INFORMATION PAGE - ITEM 3.D - ENDORSEMENTS <br />Policy Number: 72 WEC GG6484 Endorsement Number: <br />Effective Date: 08/20/19 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: SUDABEH SHOJA <br />23232 PERALTA DR, SUITE 112 <br />LAGUNA HILLS CA 92653 <br />Item 3.D. of the Information Page is completed to include the following endorsements: <br />WC000000C <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC000001A.1 <br />INFORMATION PAGE <br />WC000001A.2 <br />INFORMATION PAGE <br />WC000422B <br />TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE <br />ENDORSEMENT <br />WC040301 BB <br />POLICY AMENDATORY ENDORSEMENT - CALIFORNIA <br />WC040306 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFORNIA <br />WC040360B <br />EMPLOYERS LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA <br />WC040421 <br />OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA <br />WC040422 <br />CALIFORNIA SHORT -RATE CANCELLATION ENDORSEMENT <br />WC040601A <br />CALIFORNIA CANCELLATION ENDORSEMENT <br />WC550011 D <br />Employees Claim for Workers compensation Benefits <br />WC8804001 <br />Notice to Employees - Injuries Caused By Work (TITLE IN SPANISH) <br />WC8804011 <br />Notice to Employees - Injuries Caused By Work <br />WC9900011 <br />Signature/ Copyright <br />WC990002 <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY BUSINESS INSURANCE <br />POLICY <br />WC990005 <br />SCHEDULE OF OPERATIONS <br />WC990302B <br />WORKERS COMPENSATION BROAD FORM ENDORSEMENT <br />Form WC 99 03 68 Printed in U.S.A. <br />Process Date: 07/11/19 Policy Expiration Date: 08/20/20 <br />
The URL can be used to link to this page
Your browser does not support the video tag.