Laserfiche WebLink
t <br /> s . <br /> I <br /> i <br /> Mj <br /> r <br /> () <br /> SERVING <br /> BOARD of TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT ci,ynttom <br /> .!=3 Culbartaon,Pros. San Joaquin County <br /> I JA E.Vaitnuccl,Sacy. 1B01 East Hazelton Avenue,P.0. Box 2009 Clly of Elcalon <br /> Tommy Joyce Stockton,Call(ocnlia 95201 City of Maniacs <br /> Earl Pimentel Clay of Ripon <br /> Fufn eu®doo 2091466-6701 CIIy of Staatcton <br /> Daniel L.MONS City of Tracy <br /> John 0.Mast,M.O- San <br /> Khanna, M.D., M.P.H., Olatflcl Hoaltlt 011lCef San Joaquin County <br /> William J.Wads Sun Joaquin County <br /> Mary Anna Lova <br /> RE: CALIFORNIA-LICENSED CONTRACTOR QUESTIONNAIRE <br /> sing <br /> In order to complY with State aedYe°uirements,ewet <br /> are askingtthatoYouiprovide this <br /> Workman's Compensation Insuranc 4 <br /> d <br /> District with <br /> a information <br /> reof this letterinethe�selfeanswer <br /> addressedenvelopall etheprovided. <br /> and returnoriginal <br /> Ron L. Valinoti , Director <br /> Environmental Health Division <br /> Staal, Gardner & Dunne, Inc. <br /> 11SINESS M14E ZIP 93001 <br /> BUSINESS ADDRESS 121 N. First St. #F CITY Ventura <br /> BUSINESS TELEPHONE NUMBERS (1)$05-653-5556 (2) <br /> Ivaar Stool, David Gatdnar, Timothy Dunne, John Powell, Margin Feeney <br /> OWNER (S) (1) (2) <br /> OWNER (S) ADDRESS (1) (2) <br /> OWNER (5) PHONE NOS (1) EXP. DATE <br /> CA. CONTRACTOR LICENSE NO.not aQplicaj�e„C" INDICATE ISSUE TSPECIALITY NOS. <br /> LICENSE CLASSIFICATION (A.B.C) �_ <br /> IF 11C-51" CLASSIFICATION, INDICATE TYPE/5 OF LIMITED SPECIALITY/IES. <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD <br /> D NIADIDO? ENO— <br /> ARE <br /> IF YOU ARE SUBJECT TO WORKMAN'S COMPENSAXON LAWS OF CALIF NO , <br /> ,40RKMAN`S COMPENSATION INSURANCE? YES <br /> XX <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANC WITH TNIS'DI ICT YES , NO xxx <br /> IF YES, EXPIRATION DATE ,wry David A. Gardner <br /> - -- - -- SIGNATOR <br /> TITLE V e President <br /> DATE <br />