REMOVAL_1987 - Laserfiche WebLink

Home Browse Search

HOME OFFICE NORTHERN CALIFORNIA DIVISION 4111 West Alameda Avenue F l�a�/,■f r■tI��1TC�7I as�� tl��il■^, ■/'T,�/�■M{T+ dl I Borel Avenue,Suite 310 BurFankP O,Box a7�167750 + i i+ M(W �-`-`-'�'y�-'� CE COM P.O.Box 5908 San P.O. Calir nflu 94402 ` (818)843-0755 (415)571-1111 CERTIFICATE OF INSURANCE —WORKERS'COMPENSATION THIS CERTIFICATE IS NOT AN INSURANCE POLICY. "Notwithstand Ing any requirement,term,or condition of any contract Oro 'a, document with respect to which the certificate Is Issued,the insurance afforded by the policies listed on the certificate is subjetto _ all the terms of such policies." CERTIFICATE HOLDER AND ADDRESS: NAMEREB-AN&AODRESS� VALLEY HONEY KEN DOLLARD & VIRGIL BARBER P.O . BOX 1241 DBA : KEN DOLLARD CRANE & RIGGING STOCKTON, CA 95201 2524 RIVER ROAD MODESTO , CA 95351 —Policy NumberEffective Dater Expiration Date— F 240858/23/86 I 8/23/87 �YxCS'a>Ja1l'RYaC9K�•.JMCaX• THIS IS TO CERTIFY that we have issued to the above named insured a valid California Workers' Compensation insurance policy in a form approved by the Insurance Commissioner of the State of California. "SUPERSEDES PREVIOUS CERTIFICATE" DESCRIPTION OF OPERATIONS COVERED: All Operations in the State of California which are covered under this policy. EMPLOYER ' S LIABILITY LIMIT OF $1 , 000, 000 This policy shall not be cancelled nor reduced in coverage until after ten (10)days'written notice of such cancellation or reduction in coverage shall have been mailed to this certificate holder. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY OR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE AFFORDED BY THE POLICY INDICATED ON THIS CERTIFICATE UNDER POLICY NUMBER. WINTON—IRELAND INS . AGENCY 4-00707-1000—Q DATED AT SAN MATEO FAIRMONT INSURANCE COMPANY This 27THdayof APRIL 1987 EDP AU U-15-