Laserfiche WebLink
CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94'142 -0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03 -01 -2012 GROUP: 000496 <br />POLICY NUMBER: 0500488 -2011 <br />CERTIFICATE ID: 288 <br />CERTIFICATE EXPIRES: O1 -01 -2013 <br />01 -01- 2012/01 -07 -2013 <br />THE CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4058 <br />SG JOB:SANTA ANA REGIONAL TRANSPORTATION CTR <br />10000 E. SANTA ANA BLVD. <br />SANTA ANA <br />CA <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 />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will 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 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�e x�cl�usion�s+, and conditions, of such policy. <br />l � `Nl'NG�a L �_ <br />Authoriz ad Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - LYONS, RONALD PRESIDENT SECRETARY - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01 -06 -2012 IS <br />,ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />RUE VAC PROPERTY SERVICES INC <br />600 W TAFT AVENUE <br />ORANGE CA 92865 <br />(REV.B -2010) <br />F'LN <br />- `��'�w�JC�� X4.5 � 1_} 1'CJaa tet <br />n ` ,f I _ <br />. �___ - <br />^ih ecly_ . <br />���rnep, <br />[61 7,SG] <br />PRINTED 03 -01 -2012 <br />SG <br />�, <br />4 -� ``� E- <br />