Laserfiche WebLink
<br />' CERTHOLDER COPY SC <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 q, ~cOO~ _ ~~ ~- <br />COMPENSATION ft <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~ ~ °~~ Jr - I' ~ - 0 <br />ISSUE DATE: OS-02-2007 GROUP: <br />POLICY NUMBER: 7880289-2007 <br />CERTIFICATE ID: 23 <br />CERTIFICATE EXPIRES: 04-01-2008 <br />04-01-2007/04-01-2008 <br />CITY OF SANTA ANA SC JOB:ALL CALIFORNIA OPERATIONS <br />ATTN: SHAHIR GOBRAN <br />20 CIVIC CENTER PLZ M-43 <br />SANTA ANA CA 92701-4058 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />Calif orris Insurance Commissioner to the employer named below for the policy period indica[etl. <br />This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer. <br />We wilt also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy antl does not emend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditiens, of such policy. <br />V <br />THORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT X1600 - ABRAHAM TASHMAN PRES. - EXCLUDED. <br />ENDORSEMENT #1600 - MICHAEL BLITZ CFD SEC. - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2007 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />NATIONAL DATA AND SURVEYING SERVICES INC OBA: <br />FIELD DATA SERVICES DBA: SOUTHLANO CAR <br />COUNTERS <br />8370 MILSHIRE BLVD STE 209 <br />BEVERLY HILLS CA 90211 <br />APi ~r>=,' t-~) J,h:}~TO FORM <br />Assistant City Attorney <br />[SLC,SP] <br />IREV.4-06) PRINTED OS-02-2007 <br />