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SOUTHWEST MINORITY EDA 11 - 2007
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SOUTHWEST MINORITY EDA 11 - 2007
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Entry Properties
Last modified
1/4/2017 11:16:21 AM
Creation date
10/9/2007 10:08:27 AM
Metadata
Fields
Template:
Contracts
Company Name
SOUTHWEST MINORITY ECONOMIC DEVELOPMENT ASSOCIATION
Contract #
A-2007-097
Agency
COMMUNITY DEVELOPMENT
Council Approval Date
4/16/2007
Expiration Date
6/30/2008
Insurance Exp Date
3/25/2008
Destruction Year
2016
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<br />STATE <br />COMPENSATION <br />INSURANCE <br />I=UND <br /> <br />CERTHOLDER COPY <br /> <br />SP <br /> <br />P.O, BOX 420807, SAN FRANCISCQ,CA 94142-0807 <br /> <br />ISSUE DATE: 10-29-2006 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />CITY OF SANTA ANNA <br />CDSG ATTN: FRANK HERNANDEZ <br />20 CIVIC CENTER PLAZA P.O. BOX1988 <br />SANTA ANNA CA 92702 <br /> <br />SP <br /> <br />GROUP: <br />POLICY NUMBER: 1800611-2006 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 10-29-2007 <br />10-29-2005/10-29-2007 <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California 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 <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 conditions, of such policy. <br /> <br />Q::-REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~-J -'-~. )1..8 <br /> <br />-_...._..~~ <br />-..,L~ <br /> <br />EMPLOYER <br /> <br />!".,;::,',.';', cJ:~ '~:l~~,jy <br /> <br />SOUTHWEST MINORITY <br />SOUTHWEST MINORITY <br />1601 W 2ND ST <br />SANTA ANA CA 92703 <br /> <br />ECONDMIC OEVELPMNT AS DBA: <br />ECONOMIC DEVELO <br /> <br />(REV.2-05> <br /> <br />~ <br /> <br />PRESIDENT <br />$1 .000.000 PER OCCURRENCE. <br /> <br />"TO FOlti\/~ <br /> <br />M040S <br /> <br />PRINTED <br /> <br />09-17-2006 <br /> <br />c.) <br />
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