HomeMy WebLinkAboutECONOLITE CONTROL PRODUCTS - INSURANCE CERTIFICATE (3)CERTHOLDER COPY
SP
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
COMPENSATION
IN S U R AN C E
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-01-2009 GROUP: 000624
POLICY NUMBER: 0001005-2008
CERTIFICATE ID: 78
CERTIFICATE EXPIRES: 04-01-2010
04-01-2009/04-01-2010
CITY OF FORT COLLINS SP JOB:ALL CALIFORNIA OPERATIONS
P.O. BOX 580
FORT COLLINS, CO 80522
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, extend or alter the coverage afforded
by the policy 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 to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
THORIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2008 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
ECONOLITE GROUP, INC. DBA: ECONOLITE CONTROL
PRODUCTS, INC.
3360 E LA PALMA AVE
ANAHEIM CA 92806
M0408
(REV.2-05)
PRINTED : 03-17-2009