Laserfiche WebLink
<br />-.;,.- <br /> <br />,-. <br /> <br />~ <br />; <br /> <br />. .' \'(';C:"l~~:::'_ ~~ ~t.-"_" -,:: ;..:,;' <br />~" ' , ' " -\-' ~ '. <br /> <br />",--' <br /> <br />-. <br /> <br />""" <br /> <br />...." <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />F=UND <br /> <br />P.O: BOX 420807, SAN FRANCISCO, CA 94142'0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />JULY 8, 2002 <br /> <br />POLICY NUMBER" <br />CERTIFICATE EXPIRES: <br /> <br />1638989 - 02 <br />7-1-03 <br /> <br />I <br />CITY OF SANTA ANA <br />ATTN COMMUNITY DEVELOPMENT AGENCY M-25 <br />POBOX 1988 <br />SANTA ANA CA 92702 <br /> <br />This is to certify that we have issued a valId Workers' COllipensatlon Insurance policy in a form approved by the California <br />Insurance CommIssioner to the employer named below for tlie policy period indicated. <br /> <br />Thts policy IS not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. <br /> <br />We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance poliCY and does not amend, extend or alter the coverage afforded by the <br />policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document.)oV.i~h <br />: respect to- which this certificate of Insurance may be iss:ued or may pertain, ,the" insurance afforded by the policies <br />described herein is subject to all the terms, exclusions and conditions of such pqlicies. <br /> <br />/7~~~ <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />I(~ <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE; <br /> <br />Ah"UVu) !\:, j U FORiVJ <br /> <br />,:tJf[! .f, <br />". .If't::L___ <br />(C, "S:Il':":Y 7 -_.._--~ <br />r....'''I..'.' F" . <br />~-...... 'llY ......Jly i\!t'(f:~C'; <br /> <br />EMPLOYER <br /> <br />I <br /> <br />FEEDBACK FOUNDATION INC <br />1200 N KNOLLWOOD CIRCLE <br />ANAHEII1 CA 92801 <br /> <br />" THIS DOCUMENT, HAS A BLUE PATTERNED BACKGROUND se'F !0262IREV. 5.01) , <br /> <br />"~121'" <br />