Laserfiche WebLink
POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: O6 -14 ^2014 GROUP: <br />POUCY NUMOER: 0803748-2013 <br />CERTIFICATE ID: 1075 <br />CERTIFICATE F.XMRCS: 10 -14 -2014 <br />10-14 - 2018110-14 -2014 <br />CITY OF SANTA ANA SD <br />12 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4057 <br />This Is to corlity that we have iasuad a valid workers` Componeation insurance policy In a form opprdvorf by the <br />,.wilernia insurance Commisslonar to the employer named below for the puliay period indicated. <br />This policy rs not Subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30days advance notice should this policy be canceled prior to its norrnar expiration, <br />This Certificate of insurance Is not an insurance policy and does not ,mend extend or alter the coverage afforded <br />by the policy listed heroin. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance may be Isaued or to which R may, pertain, the insurance <br />Worded by the policy described heroin is subject to all the terma, exclusions, and conditions. of such policy, <br />Authorized Representative President and GEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2005 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -14 -2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PYRO SPECTACULARS, INC, <br />Po BOX 2329 <br />RIALTO CA 92377 <br />usrvr 1 2 n let <br />'T0 Fos% <br />SO �, 'C0 <br />itl RttornGY� <br />Assistant C <br />(P14,SD( <br />PRINTED : OS -14 -2014 <br />so <br />