Laserfiche WebLink
STATE P.O. BOX 807, SAN FRANCISCO,CALIFORNIA 94 <br /> COMPEN15gTION 107 0807 <br /> INBUR^r4C1! <br /> PUND CERTIFICATE OF WORKERS' COMP <br /> EIVSATIQN INSIJRANCI` <br /> •' POLICY NUMBER: <br /> CERTIFICATE EXPIRES: <br /> P. ..). <br /> T '' • T <br /> r t. <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 indir:ated. <br /> This policy is not subject to cancellation by the Nund except upon ten days"advance written notice to the employer. <br /> We will also give you TEN 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 fisted herein. Notwithstanding any requrre6ent, term, or condition of any contract or other document <br /> respect to which this cert;ficate of insurance may tx issued or may ,pertain, the insurance afforded b the <br /> described herein is subject to all the terms, exclus ons and conditions of such policies. y polwith <br /> icies <br /> IAI "//— <br /> PRESIDENT <br /> q rl T r r T <br /> 1 r. 1; rl is T IC T -I � ti r <br /> - i. . � Y . <br /> EMPLOYER <br /> r <br /> -I <br /> L > • <br /> SClr to�n� r+�r v, to.rr51 <br /> COPY C!� <br />