Laserfiche WebLink
STATE P.O. BOX 807, SAN FRANCISCO, CALIFORNIA 94101 <br /> COMPENSATION <br /> I N S U R A N C E <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> April 8 , 1986 POLICYNUM13ER: 571-85 #5043 <br /> CERTIFICATE EXPIRES: 10-1-86 <br /> San Joaquin Health District <br /> P. O. Box 2009 <br /> Stockton, CA 95201 <br /> L <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California <br /> Insurance Commissioner to the employer named below for the policy period indicated. — <br /> 30 <br /> This policy is not subject to cancellation by the Fund except upon j days'advance written notice to the employer. <br /> 30 <br /> We will also give you Ted 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 by the <br /> policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with <br /> respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br /> described herein is subject to all the terms, exclusions and conditions of such policies. <br /> 10-1-85 to 10-1-86 ENT <br /> Employees : Five <br /> EMPLOYER <br /> F- <br /> D L Seibold Co. , Inc. <br /> dba Seibold Corp. <br /> P. O. Box 8744 <br /> Stockton, CA 95208 <br /> L <br /> OLD 262A <br /> SCI 10262(REV.8-84) <br />