Laserfiche WebLink
POLICYHOLDER COPY <br /> NK <br /> r <br /> P.O. t30X 8192, PLEASANTON, CA 94588 <br /> f� <br /> CERTIFICATE OF WORKERS' CCMil=trNSATICIN INSURANCE <br /> GROUP: <br /> ISSU£ DATE: 05-02-2013 POLICY NUMBER: 1810627-2013 <br /> CERTIFICATE IC: 13 <br /> CERTIFICATE FXNRES: 05-01-2014 <br /> 05-01-2013/05-01-2014 <br /> CONSTRUCTION TESTING & ENGINEERING IW( <br /> PO BOX 3816 <br /> MERCED CA 95344-1816 <br /> This is w certify that we have issues a valid VVor}e,s' Compensation Insurance policy +r. a form aaproved by the <br /> California insurance Commissione, to the employe named beiovN for 'he policy Period mdreateo. <br /> rhes policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the emPiayer. <br /> We will also gine you 10days advance notice should this policy be cancelled at of to its normal expiration.. <br /> This certificate Of insurance is not an insurance policy and does not .rnend, extend or atier the coverage afforded <br /> by the poltcv listed herein. Notwithstanding any requirement, term or condition of any contract 0' other document <br /> with respect to which this certificate Of nsurance may be issuec or .e which it may pertain, the nsurance <br /> afforded by the policy described hereir. is subject to al' the term--, e::clusions, and conditions, Of such POlicv <br /> Authorized Representative Pr>sident and CEO <br /> UNLESS INDICATED OTHERWISE BY ENDORSEMENT. COVERAGE 41NDER THIS POLICY EXCLUDES THE FOLLOWING: <br /> THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br /> EMPLOYEES OVERED CALIFORNIACWORKERS'NCOMPENSATION SBENEFITS; EMPLOYEES'EXCLUDED A NDENCE ROCALIFORNOLICY ICALIFORNIA <br /> COMPENSATION LAW. <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE, <br /> EMPLOYER <br /> LAMB, GROVER C (JR) DBA: ALL STAR DRILLING <br /> PO BOX 2146 <br /> CERES CA 95307 <br /> [41M,,CNI <br /> PRINTED 05-02-2013 <br /> (REV.1-20)2) <br />