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Last modified
2/15/2010 9:03:22 PM
Creation date
1/6/2005 7:43:36 PM
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General
General - Type
Insurance
General 2 - Date
12/28/2007
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CERTHOLDER COPY <br />ISSUE DATE: 01-01-2010 <br />CITY OF RIVERSIDE <br />ATTN FINANCE DEPT <br />3900 MAIN ST <br />RIVERSIDE CA 92522 <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />RECEIVED <br />;iTY OF RIVERSIDE <br />JAN t) 5 2010 Si <br />RISK MANAGEMENT <br />GROUP <br />POLICY NUMBER: 1814853-2010 <br />CERTIFICATE ID: 4 <br />CERTIFICATE EXPIRES: 01-01-2011 <br />01-01-2010/01-01-2011 <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 />17V~A <br />7HORIZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1800 - PATRICK T HOPKINS, PRESIDENT SEC, - EXCLUDED. <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2005 IS <br />••r•-••••• ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />ICON <br />1814 COMMERCENTER W STE A <br />SAN BERNARDINO CA 92408 <br />Si <br />Si <br />M0408 <br />(REV.2-05) PRINTED : 12-17-2009 <br />
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