Laserfiche WebLink
CERTHOLDER COPY <br />P.O. BOX 42087, SAN FRANCISCO,CA 94742-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10-31-2071 GROUP: 000719 <br />POLICY NVMBER: 0000320-2010 <br />CERTIFICATE ID: 23B <br />CERTIFICATE EXPIRES: D3-19-2012 <br />03-19-2011/03-79-2012 <br />SANTA ANA STATION DISTRICT HOUSING SK JOB:SANTA ANA STATION DISTRICT. PHASE I <br />PARTNERS L. P. <br />79207 VON KARMAN AVE STE 900 <br />IRVINE CA 92812-1097 <br />This Is to certify that we have Issued a valid Workers' Compensation Insuranoe? policy In a form approved by the <br />California Insurance ?Commissfoner to the employer named below for the policy period Indicated. <br />This policy Is not sub]ect to cancella[lon by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notloe should thts polloy be cancelled prior tc Its normal expiration. <br />This certificate of Insurance Is not an insurance policy and does not emend, extend or alter the coverage afforded <br />by the policy Ifs[ed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />w)th respect [o which this eertif lcate of Insurance may ba Issued or to which it may pertain, the Insurenoa <br />afforded by the policy described herein Is sub]ect to ell the terms,?/??/?x?clusion?sr, and conditions; -of such policy. <br />t ? `eYHt+a C <br />Authorized Representa[IVS President and CEO <br />EMPLOYERrS?LIABILZTY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2066 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-19-2009 IS <br />ATTACHED TO AND FORMS A PART OP THIS POLICY. <br />??? <br />EnnPl_oY£R LISA E. STORCK <br />Assistant City Attorney <br />_. <br />PORTRAIT HOMES,INC SK <br />2B6 N JOY ST STE 200 <br />CORONA CA 92979 <br />IB1 £,SK] <br />PRINTED 10-37-2071 <br />SK <br />IRE V,6. 2010)