Laserfiche WebLink
<br />A - 2vo2-- /C:>~-// <br />j-\---2oo2-loS--/;2.. <br />'-' CERT'ooltATE HOLDER COPY <br /> <br />STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br /> <br />FU NO CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />NOVEMBER 18, 2002 <br /> <br />GROUP: <br />POLICY NUMBER: 1717320-2002 <br />CERTIFICATE ID: 6 <br />CERTIFICATE EXPIRES: 10-01-2003 <br />10-01-2002/10-01-2003 <br /> <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br /> <br />AGENCY <br />M-25 <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 />/~~ <br /> <br />f(~ I> LL.-':-..,.. <br /> <br />PRESIDENT <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE <br /> <br />EMPLOYER <br /> <br />APPRO V ED AS TO FORN! <br /> <br />(6 <br /> <br />Laura Sheedy <br />Deputy City Attorney <br /> <br />COUNCIL ON AGING-ORANGE <br />1971 E 4TH ST #200 <br />SANTA ANA CA 92705 <br /> <br />COUNTY <br /> <br />selF 10265 <br /> <br />IEPF.UI, L 11 <br />