Laserfiche WebLink
<br />Jan 08 2008 3:57PM <br /> <br />COMMUNITY#SENIORSERV <br /> <br />7148167397 <br /> <br />p.4 <br /> <br />CERTHOlDER COpy <br /> <br />sc <br /> <br />STATE <br />eohl...NSAT10N <br />INSU,.ANC. <br />F=UND <br /> <br />P.O. BOX 420807. SAN FRANCISCQ,CA 84142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />. XSSUE DATE: 07-1t-2OO7 <br /> <br />GflOlJl>: <br />POliCY NUMBER: 18388..-2007 <br />. CERTIFICATE 10: 87 <br />Ce:RTlF'lCATE EXPIRES: 07-01-2008 <br />07 -01-2007 fD7 -0 1-2001I <br />nus CERrtFICATE SUPERSEDES AM) C:OlUd!crs <br />CllIlTtFll:ATE # 12 l>>.TlD 07-01-2007 <br /> <br />CITY OF SANTA ANA <br />COMMUNITY DEVELOPMENT AGl!NCY M-2& <br />PO lOX 18.. <br />SANTA ANA CA 82702-1..1 <br /> <br />SC <br /> <br />This is to certify tlurt we Mote ill8ued . valid WOftI.er.' Compenutlon inMJrM'ICe policy in a form approved bv !he <br />California Insur..ce Cclmmiuionet" to the .~loyer _II below for the policy period indie&ted. <br /> <br />This policy Is not subject to D4lleelliltion Dv the Fund except ~on 30 liIys ~ written notiCe 10 the emplover. <br /> <br />We will aI$O gille you 30 days .tvance notice should this po/jcy be C*leelled prior to its normal expiration. <br /> <br />This certificate of InBlI'lnce is not an. iMUrlnCe pollcv m does not M'lenct extend or .lter the cownge ..fforded <br />by the policy listed. herlJln.. NotwIthstanding ..,y requirement. Will or condition of any contraet or other document <br />with respect to whlC/l this certificate of ill$urance I'lWi be IcalNld: or 1c which it I'II8Y pwtain. 1he Insurance <br />affOl'ded by the pOlicy described herein is subject to .,1 the terms, exclusions. II'Id conditions. of such policy. <br /> <br />tt::--~ <br /> <br />~~~.- <br /> <br />PRESIOENi <br />ENPLOYI!R'S LIABILITY UNIT INCLlmING DEFENSE a:JSTS: $1,000.000 PlR OCCUUEtCE. <br />ENDORSEMENT' .12081 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2003 IS <br />ATTAOtEO TO AN) FORNS A PART OF THIS POLICY. <br /> <br />..'~~..:.' 1;' ~"~.j / '.~.' _: - <br />~ /j",Jo..) <br /> <br />'.,....".~, <br />1: "j ~ORM <br /> <br />EMPLOYER <br /> <br />-'--,-- ~ <br />. . -- <br />.. .\.. ~ -- <br />A '--~,,,.2 ~ '-' t~ At,~'p~ no' <br />VJ. '4'-") <br /> <br />cc.uNITY SENIORSERY IN(: DlA: FEED8ACIC SC <br />FOUNDATIDN. INC DIA: SENIOR MEALS AND SERVICES <br />INC <br />1200 N KNDLLWOQD CIR <br />ANAHEIM CA 82101 <br /> <br />(REV _z.(~5! <br /> <br />PRINTED <br /> <br />[B11.SG] <br />07-11-2007 <br /> <br />