HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - STATE COMPENSATION INSURANCE FUND CERTIFICATESP
CERTHOLDER COPY
STATE P.O. Box say, SAN FRANCISCO,CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-01-2003 GROUP
CITY OF FORT COLLINS, CO
PO BOX 580"
FORT COLLINS C0;80522
POLICY NUMBER: 1603984-2003
CERTIFICATE ID: 25
CERTIFICATE EXPIRES: 04-01-2004
04-01-2003/04-01-2004
SP
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 named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer.
We will also give you 30 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, extendor alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the
policies described herein is subject to all the terms, exclusions and conditions of such policies.
AUTHORIZED; REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE.
ENDORSEMENT''#2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2003 IS ATTACHEDTOAND
FORMS A PART OF THIS POLICY.
EMPLOYER LEGAL NAME
ECONOLITE CONTROL PRODUCTS, INC ECONOLITE CONTROL PRODUCTS INC AND/OR
3360 E LA PALMA AVE ECONOLITE TRAFFIC ENGINEERING & MAINT.I
ANAHEIM CA 92806
IREv.3-031 PRINTED: 03-17-2003 P0409