HomeMy WebLinkAboutCITY OF FORT COLLINS - INSURANCE CERTIFICATE (13)CERTHOLDER COPY
NE
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10-14-2009 GROUP:
POLICY NUMBER: 1882297-2009
CERTIFICATE ID: 287
CERTIFICATE EXPIRES: 10-13-2010
10-13-2009/10-13-2010
CITY OF FORT COLLINS NE JOB:ALL PROJECTS
PO BOX 580
FORT COLLINS CO 80522-0580
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 10 days advance written notice to the employer.
We will also give you 10 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.
=HIRIZEDREPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE
EMPLOYER
STC NETCOM, INC NE
11611 INDUSTRY AVE
FONTANA CA 92337
[B1R,NE]
1REV.2-051 PRINTED : 10-14-2009