Laserfiche WebLink
Ar 2®i q` 1/ — 0 I CERTHOLDER COPY <br />P.O. 80X 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03-01-2015 GROUP: <br />POLICY NUMBER: 1555105-2015 <br />CERTIFICATE 10: 22 <br />CERTIFICATE EXPIRES: 03-01-2016 <br />03-01-2015/03-01-2016 <br />CITY OF SANTA ANA SP <br />BENEFITS DEPARTMENT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 82701-4058 <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, exclusions, and conditions, of such policy. <br />�Vct, �jfQ YLq" <br />V4, <br />Authorized <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - MARCUS D DAYHOFF, PRESIDENT CEO - EXCLUDED. <br />ENDORSEMENT #1600 - LETICIA A DAYHOFF, ',SECRETARY TREASURER - EXCLUDED. <br />ENDORSEMENT #2066 ENTITLED CERTIFICATE ':HOLDERS' NOTICE EFFECTIVE 03-01-2000 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />REACH EMPLOYEE ASSISTANCE INC <br />850 N ROSE OR <br />PLACENTIA CA 82870 <br />SP <br />M0408 <br />PRINTED : 02-17-2015 <br />(REV.7-2014) <br />SP <br />