Laserfiche WebLink
<br />Feb'11 05 09:58a <br /> <br />p.4 <br /> <br />. <br /> <br />CERTHOLDER COPY <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142~807 <br />COM~EN5ATION <br />INSURANCI! <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 01-12-2005 <br /> <br />GROUP: 000713 <br />POLICY NUMBER: B86~ -200~ <br />CERTIFICATE ID: 354. <br />CERTIFICATE EXPIRES: 11-13-2005 <br />11-13-2004/11-13-2005 <br /> <br />TEB IRVINE COKPANr OFFICE PROPERTIBS <br />630 NEWPORT CENTER DR. STE.#100 <br />NEWPORT BEACH CA 92660 <br /> <br />JOB. ALL OPERATIClIlS <br /> <br />This is to certify that we have Issued a valid Worker's Compensation insuranoe policy in a form approved by the Ca:ifomia <br />Insurance Commissioner to the employer named below for Ihe porlCY period Indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the empioyer. <br /> <br />/ We will also give you 30 days advance notice should this polley be cancelled prior to Its normal expiration. <br /> <br />This certificate of insurance is not an insurance poley and does not amend, extend or alter !he coverage afforded by the <br />policy listed herein. Notwithslanding any requirement, term or condition of any contract oc otI1er document with <br />respect 10 which this certificate of insurance may be issued or to which It may pertain, the Insurance afforded by the policy <br />described herein Is subject to all the terms, exclusions. end conditions, of such poliey. <br /> <br />~ <br /> <br />,&~ c. eL <br /> <br />AUTIiORlZED REPRESENTATIVE <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1600 - lIIAUREEN V JO!roY, PRBSIDSNT TRE - EXCLUDED. <br /> <br />EllDORSEMENT #1600 - ItEITH S VOYSBY, SECRETARY - EXCLUDED. <br /> <br /> <br />ENDORSEtIENT #1500 - MIRE CURREY, SEC - BXCLUDED. <br /> <br />ENDORSEMENT 111600 - CHRIS TAYLOR, TRES - EXCLUDED. <br /> <br />ENDORSEMENT #1600 - CHRIS FLANDERS, VP - EXCLUDBD. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-13-2003 IS <br />ATTACBED TO AND FORKS A PART OF THIS POLICY. <br /> <br />ENDORSEMENT 112570 EllTITLED WAIVER OF SUBROGATION EFFECTIVE 01-12-2005 IS <br />ATTACBED TO AND FORKS A PART OF THIS POLICY. THIRD PARTY Nl\KE: <br />THE IRVINE COMPANY OFFICE PROPBRTIE9 <br /> <br />APPROVED AS' <br />r, TO PORM <br /> <br /> <br />- <br /> <br />E~OYER <br /> <br />ADVANCED AtlTOMATED SYSTEMS mc AND/OR AND/OR <br />