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HOTLINE OF SOUTHERN CALIFORNIA 4 -2002
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HOTLINE OF SOUTHERN CALIFORNIA 4 -2002
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Last modified
1/3/2012 2:56:33 PM
Creation date
4/17/2006 11:08:08 AM
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Template:
Contracts
Company Name
Hotline of Southern CA
Contract #
A-2002-105-20
Agency
Community Development
Insurance Exp Date
11/26/2003
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<br />'-' <br /> <br />fJr - z-CXJ.,)- - I oS- -.;:LO <br />CIlooooiIFICATE HOLDER COpy <br /> <br />. <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br /> <br />FU N 0 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />APRIL 18, 2002 <br /> <br />GROUP: <br />POLICY NUMBER: 1332857-2002 <br />CERTIFICATE 10: 1 <br />CERTIFICATE EXPIRES: 03-01-2003 <br />03-01-2002/03-01-2003 <br /> <br />CITY OF SANTA ANA <br />ATTN: LUCY FLORES <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />PO BOX 1988 <br /> <br />This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California <br />Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br /> <br />We will also give you 10 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 with <br />respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br />described herein is subject to all the terms, exclusions, and conditions, of such policies. <br /> <br />-c5 <br />/~~, ~ <br /> <br />I( t!.4 0- -l..~ J ..."", <br />PRESIDENT <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br /> <br />APPROVED AS TO FORM <br /> <br /> <br />aura Shc;.:dy <br />Deputy City A torney. <br /> <br />EMPLOYER <br /> <br />HOTLINE OF SOUTHERN CALIFORNIA (A NON-PROFIT CORP.) <br />PO BOX 32 <br />LOS ALAMITOS CA 90720 <br /> <br />selF 10265 [EPF-UI: DB] <br />
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