Laserfiche WebLink
POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-15-2018 <br />CITY OF SANTA ANA SIP <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />GROUP: <br />POLICY NUMBER: 0803749-2017 <br />CERTIFICATE ID: 1648 <br />CERTIFICATE EXPIRES: 10-14-2018 <br />10-14-2017f10-14-2018 <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 <br />�described herein is subject to all the termmss,, exclusio�ns,s,��CJ�Jannd conditions, of such policy. <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT R2065 ENTITLED CERTIFICATE FOLDERS' NOTICE EFFECTIVE 10-14-2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PYRO SPECTACULARS, INC. SP <br />PO BOX 2329 <br />RIALTO CA 92377 <br />(P1Y,SDI <br />fnev.7-2314) PRINTED ; 01-15-2018 <br />