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NABIH EMAD
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Last modified
7/11/2012 11:46:36 AM
Creation date
7/2/2012 2:41:27 PM
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General - Type
Agendas
General 2 - Date
7/2/2012
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CERTHOLDER COPY <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS` COMPENSATION INSURANCE <br />ISSUE DATE: 47 -41 -2012 <br />CITY OF RIVERSIDE <br />PUBLIC UTILITY DEPARTMENT <br />3900 MAIN ST <br />RIVERSIDE CA 92522 -0002 <br />Sd <br />GROUP: <br />POLICY NUMBER: 191 8394 -2012 <br />CERTIFICATE ID: 8 <br />CERTIFICATE EXPIRES: 07-41-2013 <br />07- 01- 2012/47 -41 -2013 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 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 <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br />Authorized Representative President and CEO <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br />EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br />CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />COMPENSATION LAW. <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,004,000 PER OCCURRENCE. <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -01 -2411 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />NABIH, EMAD <br />8715 PREDERA CT <br />RANCHO CUCAMONGA CA 91730 <br />Sd <br />SJ <br />M0408 <br />(REV.8-2010) PRINTED 08--16 -2012 <br />
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