Laserfiche WebLink
E P.O.BOX BOA,SAN FRANCISCO,CALIFORNIA X01 <br /> cOMDEC19$0 <br /> IeINe^TIO N W <br /> �IrlsuwAlVcs � UES O <br /> FUND CERTIFICATE OF WORKERS'COMPENSATION UF" w <br /> DECEMBER 22. 1986 571- jUNIT 005039 <br /> Q�f NL9ABER: <br /> CERTIFI t,,FXPIRES: -a� <br /> 4168L9c> <br /> r <br /> SAN JO AQUIN LOCAL HEALTH DISTRICT <br /> P 0 BOX 2009 <br /> STOCKTON <br /> CA 95201 <br /> L <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 poligy_period indicated. <br /> This policy is not subject to cancellation by the Fund except uponXeX days'advance written notice to the employer. <br /> 30 <br /> We will alio give you II 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 listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with <br /> respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br /> described herein is subject to all the terms,exclusions and conditions of such policies. <br /> PRESIDENT <br /> ENDORSEMENT 52065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE <br /> 10/01/86 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> D <br /> EMPLOYER <br /> r <br /> CLAUDE C WOOD CO <br /> P 0 BOX 599 <br /> LODI <br /> CA 95241 <br /> L <br /> e^,rnnen ,eev n_neOLO262A <br />