FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

10/19/2004 TUE 09:05 FAX 121002. r NF t POLICYHOLDER COPY r STATE ' P.O. Box 807, SAN FRANCISCQ,CA 94142-0807 COMPENSATION IN5tJRANcr= FU,N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATC: 10-01-2004 A GROUP: POLICY NUMBER: 1759401-2004 CERTIFICATE ID: 22 - — - — - CERTIFICATE EXPIRES: 10-01-200S.-- '10-01-2004/10-01-2005 0-01-2005._-'0-01-2004/10-012005 SAN. JOAOU•1 N COUNTY ENV I:RONMENTAL NF i 304. E WES R AVE ,3RD FLOOR i STOCK-TON CA 95202 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California,insurance Commissioner to the employer narnbd below for the policy period indicated i i I This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. I ' i `r We will also give you 2Q..days!'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an Insurance policy and, does not amend, extend or alter the coverage afforded by the policies lisled'he6eiq.,NotivithstandIng any requirement, term, or condition of any contract or other document with respect fo which this certificate df insurance•.mav be issued or may perthin, the insurance afforded by the policies describbd herein is subject to all.the .terms exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVS PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000.00 PER OCCURRENCE.. I i ENDURSEMEN7 0085 ENTITLED CERTIFICATE R0LDERS1'.NOTICE'EFFECTIVE 10-01-2004 I5 ATTACHED TO AND ' i 'FORMS A PART OF THIS POLICY. ' 1 r EMPLOYER LEGAL NAME I V ai W DRILLING.; INC.. V & W bFIXI-LING, JNC. , PO BOX""lib I SLET•ON CA 9564.1 I� 09/17/2004 P041 t7 WEV.3-03? PRINTED; I - .. --..__.. -.. ._�__ - • _ - -�.-...,.ter- "