JOHNSON FRANK & ASSOCIATES 3 - 2006

Home Browse Search

CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94742-0807 COMPENSATION I N S U R A N C E FU N ? CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-26-2070 GROUP: 000092 POLICY NUMBER: 0000197 8-2009 CERTIFICATE ID: 245 CERTIFICATE EXPIRES: 01-01-2077 01-01-2070/01-01-2077 CITY OF SANTA ANA SG BUILDING & SAFETY DEPT PO BOX 1988 SANTA ANA CA 92702-7988 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer Hamad below for the policy periotl indicated. This policy is nol subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We w111 also give you 30 days advance notice should this policy b® cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. V G/ THORIZED REPRESE NTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: E7,000, 000 PER OCCURRENCE ENDORSEMENT #1600 - ROGER FRANK PRES - EXCLUDED. ENDORSEMENT #7600 - ALAN FRANK S.T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS ATTACHED TD AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED MAIVER OF SUBROGATIDN EFFECTIVE 2010-01-2B IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA EMPLOYER JOHNSON-FRANK & ASSOCIATES (A CORP) SG 5150 E HUNTER AVE ANAHEIM CA 92807 SG [Bt Q,SG] IfiE V.2-o51 PRINTED 01-26-2070