Loading...
1999-0101_CALIFORNIA TRAFFIC MAINTENANCE_Workers' Comp Insurance .. -.. 771711.7.17',1%. ,..V.ffk;., ;...L',. ." • '.' 7 ?•7-''''''''-'''','C'r,"'",'7,,,,it'Ve7-r--.74f4Y:t.7%.,-.Tr.,,,'i.: 7 ::-',:..,,,.i,, 77, .'',,,•1•''.:.,,,.;•7T...!T,,•:,I'': ''. ..;,..•.i.:,*, ,,,,....,,,,,.. ,,..4?,*,..,...;,,,,,,.:,...i.,..-?.::, ,,,..,,-.., A '4.•,;.7,,,,-..L2:.!;;;.t.„,.4.:,.,-,--:;.,....,f,..„„.'",',,,,,,:,, ,,::::, ;,,, -:'' :-:::..:q.f.,I, f. .4. ' it-*,I ',' -7.71.7:- .7i7,,'.;,.41,',,t -,,,..,,-,,.::.„,.:',* :-,:, ,' :,;:.'•-' ,,-- '--* * -' '*'- ' - 1,7:',,,g,",,,,. ..,,, ,,,-*r,;,: lk1',.',#,, ,It' :,''',',-7,ik,,',2''',-'' ' 0 STATE P.O. BOX 807, SAN FRANCISCO CA 94101-0807 --,;,,.,,,,:::,,„,,, '>,: ,•?-*-1 .1V;;;,'"1. •,,,' '' ', :'''-',',.‘',.,‘'.17.::.- 1','.•-....'i :i.. ,INSURANCE ' COMPENSATION , F LJ I\1 D , CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ifk:_., (. " POLICY NUMBER: 046-99 UNIT 0007629 .1',,,7 „,?:,,'" ,',-• , . ••,,, ,.,-' ••*2 EXPIRES: 01-01-00 vilelaw7,1110. .•'., ' ISSUE DATE: 01-01-99 ::''.:'1 ;'...S.',..`7,. "44- F., : : CERTIFICATE:::. . . ..z., -,' 4.*,..N,'.'•:- • tilt,''",- ol :,:,...,-....4:-.4.,....... ,..,..:.1.,.. ..i......,;:..!.;:::,:,..:.,.,-,--.•.;-,..,,,,': .... , „ .‘4.- . . ,..: .,, ,._. ,.,,-...,....-:::..4ilia..;.....,,,.,.',.,:., ,,,,t-,,-, " ...lg.4..,. . !t,.. - . ,... CITY OF SAN JUAN CAPISTRANO JOB: APNAVDEMREEMNOTVMAALRKpI.NoGoMi5A0IN8T4i ' • 4 ATTN:DEPUTY CITY CLERK,DAWN S CH AN D E R I ,,; , .'f,',''A•li:',, _ ,, ,... ,.... _ 47.:,;, 7,.:;':,,,'.4...,...`1,5,,,, •,' 214.00 PASEO ADELANTO AN JUAN CAP I STR AN 0 CA 92675 , ,..„,, ' 4:i.':,:. 4;-.; 1k1‘;:,,':4,'..-,...'':',..', .,,,rt..., i1'•, .,"..... „0,.,, ,i, ,; . -?4 ' lP 4 . , i.:-. .',-,'•:.•-,,,.;',‘,'.','•,': 4.,N....._ As7rtt--,4., • ,.,.',i 4 -•— ..,,,w^k - •, ,.•••,•,;,!, , " ,,,,,,,,,.-,.1 „, ,,,,,,,,-:',,,,,l, , ;.,, ,.•,. .;",,• ;.,,,,,,,,,,,-0-s„.,,,,,,. „,,,,,,,,-;a7 •,-,1 , „, .-,,, ,,,,,• ii,.4e44:13,,,!„.„4,7*., 'it''..7:i,,,,,,s,,,,,„41.4rill'O-%"°,,i4t,-,,•Avo'0. 4",.. 41400i,*•,i.',;„:••4-,,,,:-.: ci,,,,..#„,alit;',,' ,,'.,:,`c.,,,,,.,,,s4,1A'''',41,H:j,..il.%°,.4,2,,,,-A,•• ,,,:sj, 4-f-...,4,P.,;,,,,,.x,,:•',0-6-,,,,,L.,. .:Jc-,:•,..„:...,,i4k,,.''''',7e.. .714,,t,.i...4.A....: 4tC7'•',..-r„,"X"-:-.„ „,:.,.-,,A., 4117,„ ,,, ,,„,-.44..;,,,,..,'"4,,...,,.;.:.•--/-`',,,,,,,..,.;:;,..4i.,711. ... i.. This is to certify that we have issued a valid Workers' Compensation insurance policy in a from approved by the ,"4:..-:,-, . 71,,k,,,,,,,,..!Iii, ....1,„, "•••'-..1..‘. '1 California Insurance Commissioner to the employer named below for the policy period indicated. .',......ie,,j--..,, ‘,.-,..45,10.,..,..2,-..--t --`, ,...':.,.,... . ,:. - ' $ This policy is not subject to cancellation by the fund except upon 10 days' advance written notice to the employer. t ; . ,. „,.,,,.,„,,,,,.,.,, ....„,,...„,„,,,,,,,„,,.,,,,,,,..,*,,-...,,,,,,::,,,:?*•,,C,,--,-,?,,,,,,-:`,M,.",,,,-A'i,,-,,',"-'444-,.-,•., '.- --,,-, —'. ..,,,,,..,,,,...;-,::„0.,..,,, ..,,,,,e0,7.,,,,,,,,,,,,,,---,,,. .. :,-,-,-. . ......, . -- t We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. .17' ".q1%.,:, ' :-.,,,,,-• ,,,,',,,,,_,":4'7".:,,,c'.,.4.'1 ..',1'..,, r This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage 1 afforded nt '....': ,:,.:.:r,-....f.,.::, 1...:by the policies listed herein, notwithstanding any requirement, term, or condition of any contract affordedorothbytheerdoc ;..(,... ,,,..„. u .,,,:,,, ,. .. .., with respect to which this certificate of insurance may be issued or may pertain, the insurance''..'. policies described herein is subject to all the terms, exclusions and conditions of such policies. . ....,.... . - - ',- • ^ ' ' - .dik....,A,,,,:,:,,,,:;.,,,,T4.:. tt1/4;,,V-,iir,',18‘7&'.Yr•ii,--„,.‘f.,1-,lf... ':.:9K,'4,..-t"...,,,,»",,,P....', ..,,,,,',.<,',,-,,,,,-,,-, ,1,,,,,,,--, ,-,-4--4,,,,,,',Y, ',..,,,i,-,„:',„-ri,,.,,,,,,-,,tl,'.',,,'' ,,,,",:,-,,,,:::::.....ii,,iA,!:-:,,..,:.;:;';',')',',..,,,'',::.,,,,,s,•••••.,:.'-,:','-•.:',.:'-:::,: ,,,,„',:...- ''''':'''''' '''''-'''''''''4''''' ,. l'.21,**-:'.07'?:-.:e,-I''',,-*;-*Y:'''4'''-''',{-'i7. :1.:.IIP,::•:•.,:',4'.'''''.,"4310;4::-?',.;:S:WN:::!0:',.:.,,:, j-,;44, :f4410,:ii'iY'*,-. : ef:;?4:4.';'k:,''4.'..--''A':''- ..., ,,. ,.. PRESIDENT ".,,,.,''3 ..- ',".,',:t!•,,-, .,z.'-'1 - `;il. i,,,, . ,,. , ;;. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE.' .-!' ,,,,,,,... ,14.:., . ea ,, oc,,i.r.t• '..,..1 •,• STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE ';,,,...,:i.:,,,":;:..... 44,,,,. FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. _ , , , , ,_.,:,,,,,,,...t..,..,. ....„..,.4),"7.044....t,,,::.,,,,,,,",r,,,,,,,,,,.,,,,,,L;•..,:-.7.,:i.t,,,,„.i..,„..,.;,,,ise.,,tit,...4 - - - , , 2.',',,,••.19;4,,•!,4.V...,144;,;-,,.,!;,,,..'1...4A.4.„5-4'411,,..7it...,...,..•••.. 8 ,-.r-gt1,...i..,:.;., ,,,..„. • • . .1-,:,...,;.,,,,t4.,$)_"6„,7,,,,....ii: .,,,,,,!,.4.1,:4•,,,,,,r -,.,.,,,,, ,.-.1,44,-4,,,,,, ,k+' .4.„' *; ."'-•*r ,,z,•;„:). '7,44,7•,. .-.;,,,,A.,:Se-.,i';',.1 ,7.,,,,4i.I.,,,'"i!'%',. .t4ilti, ":,...,,7!;" •,., ,.."•.,„..0;,...• * •- t,;,' 4,4,4‘. , , k,N,7 :;,"r7,4‘ "'",-„- '', ,''.!,',-.*,,,,r.4.i .;,',T*,..,:iif:<.':i, ,''''''4.':',,' ''',*'' '4, -"' - -'•''' =I ••t';',"" •" :,i,tr? •., ,„,,,. '1' %IT; ;7J1-V.Vit:i::::"4'..'."'...'' . .,.i.1-:','":.•7...::--'7^'," 4.'",-,V'4'`'7,. .1';21,,•.'- , „, 4, p.,.,, t, •,!,/ iii,.. , •;:!`"`,...- ,:),,, •,,',-- ..,,,,,,c,;-, ',1',• .., •,,tt,' ,tz,":,.:,•.'•;,,,-- ,„'"le., •,,,', .-•.••,,.....'y -4,4',,-;,,,,,,,,,.,-: -,*••0....,,•'''-',,,...'" '-- ' '4.s., 1 .,-i.--'1,.. ,.,'.,- : .:,'',.. .',,,-',,,,.:';',..1' ,, ,,,,ti ' r.-....) A''''''''-- ''''''--Pf:' 7-ii". ''70',4'•,-';,,krl'.-'4.'',.,:':',,:,+:,f.,,1. :-.,,- '.„..,.. ' .,!. A,, ,....„„: f1.,, ,‘.'4:.r1:,, --. i,. '- ,,,,'..,:. .,.1. ,,,-„itti,-.-...,,,, -,- . ,,,,,,. - .7.1,..- :pi.'-',' .._. --,.. (=;) ;,!...,,,;.;,4. ,,,,,• ,.,..-,,,,--, :, ',,,,.:, -i...;:..*.-:,',., - ..;;4,..1K.,:',,..44,,r-i :,'4:•7: -, '..4'..i.-.1:ii.:*,4*•.t 1 '''' ''"'" . ... . e..q.'. _,,,_,,,O.,;;,',1 r ,' 4,, ' '',.. '''.•''',.,,,.1.:'!.'', .' ',,,,„."1.,,,,, , ,, ,,,, ,,;. .,,,,,',,,.%.:,','.',,`,,,-.,4.",,'5 IC-,:',, ,- )!.., 1'' '-,,v.j.r.4 ,',....' :-1,,w..-: .?."'. 7,-,:..,•.ei„.:.:,,:,:,,i,: ..z.,'-..v,-;:::,,,i,, t,!.;.:'...,-•,;_:..., - -4,,,-k'..)‘:-.,,-.,---1,..,...'74,.4,,,,,,....ti4;',.,,..,...,.1... ' . '..-"". frl '- tktt.,.-' - ,..r,• ::',*,,.7.1'."?. $!!•.ft,: . ; , a,,zT,,, -.A. ,, 4. :;:,..-1,,,ri:.•..,- ,ez,:,,. -: ,,-„,„.,t,„,,,,sii.,,,,,,,,A,,sr-,,. -,1' -1,.,- „-7 4,,,-,it.r:),..b.,,..-•:1;i0--"P!' •,.L.-,..6,:.:7...';',,, ,,-..•..,..!:'' , i..1 , --- , il,...r '......, f-,..,;•7.7.' - .1,,,,.. ..-.,--,4,.' r ,..',,,,,,.,,; ,. I:,•'111, 4'. 't,,',,,„, ...41,,:1,,.-,,,,,,t,'„,•,:•ti:,;,?„.; .,,,,k; ,,,,,lis -,.-,. . _ ,4,...,,,„ ;,,:_ - _,. 0-) g .. :::.:::,,,,,,, '''! .,,/,., ,-,. -14i ''',.-,' : ' , '4',.. '' ,...LP ,:5',-,'W"--,47..,,:,..,• - • ,,,-......• -,-,-,.,,,•-„,-,- 1,:-. ....:,,,..,„:.,.1 i',V.I'.....,,f,t4,.,..-e••..* ..,,,7 1:.,,( :.,.., . . —r.r. . ,.-,,,;r.„,,,,,.1,,, :, --- .. . .'•,-A'c • ,;.,.„..,-,,,,t,,..t.,,,,:„:-..,..J,,,H.•...-s.,-,. ;.-,:: ,.-,.,,,:, :,,,,,i-;-,-,;-0,,,, ,,-„,„!„..:.-..;..,-- „.„-„,,-,,,,,,.,J,..:,;.:,... •4-.,i444,,, „•,;•',;7,,,,yir,•••"-,t-',',44.."••':,'.. . .•!,:',,i..',.',;,,-,:,:.'i;t:- ,,.;.t . ... ., ;',.'tilt:.''',:-:';,j2e.F'I ', .'7'• ' •:-f't.•'f:.,,,,,Ak'.:... ,,-'''•',.,, '''.6. ,1•f.ii:- L° .' . .., ..,.. co -,:i'i,ia, • ..,: .*,''',.', :x: ; . ,"' ', ,, :,,,:. ,,,tt14,1:,,,,,',.,..,.!1'..",.T1'?"',,-"..'1';',:,',' '..',....'"'"-'`14,:',..V.,..'-1 .V7.„':-- ., . , ,--::7,.. 'skt,'•'--7,A- '' 101,.,, ,,',.'1,' l'--4-4 -, ,4 *„i-...q,,,..;,,,,,;,40,.1f:: ',,,710i'l !,'.",.,.'Y,;' ,:74,,,, ' 14.'1', '.''''-''-'', -- - -' ,,,,.,;,,,...., ,' : 'if',,,,,,,,;,-,;,-11-91 7V,'-:-",',4*,',', .,,t,,;,i...":',;• AA,..4Z4A. 1:?....",, ,.? 'A:A 4 7,17,,,,P '.t,, '"-,,,,tti,f,:1,,,,;r, ,,,t1r;?"4"e7,,,,,, ''?'...1.)-i:;..N.7',,, ".%.,,,.• ,., ''1,....:,,-,,,,•••;':..,q--', " t.94, f 1., . ....„..,..:,,,,,,,,.„i,,,,,,„:„ . .„:,:,,, „„., ,4,. ,:,...r ..47,1:,•,....r.. ..,,,,,7,,,w- 7 to,,.",..7..-",-..._*..,:,'' -41.t,::',''t.tt;,',.4..'7'-",••;,:I!,..'"%./-24,;,,t,7"."' ' ."..- e..•:,-., 4,y,,,t ,,,,,,,. ," ,,,i„-.'.4 ...,.,f..4.- •'-'r ;-e-ri, t,''.44,':*,;•'?i4..„,,;-''.:',,ii ..,...,!,:etL..*,..; , ,:*.,- ,,i.E.,.,,,,...-,„Algt„, -,,;:„.-,f,,,,i,,,,,, .,*,-..-*',ICk.:.:..„'''.%,,,,,,iV:,i,,, ,, ,,::"' ,.^- ;,,,,;„*:,;, _.4 ,f,,,,,,,:,e, .. ,,: p,.,,,e, , ...,,e,...,z...,,L<:,,,...T:,;.,„%-,„;. , 'X'_„,,,,-., '"',4"*"7: :,,,,,-;*.—-',11:',,,Z2,,,,,-„-',V:.',,,,..',y,,?i,',:,:',..,, ,,,,c.4., , -,,,,-,. '4.,, ,,i,,,,e,',,-,,,,,,,ii ej,':,':,z,„,,,,,.',04'..',Y-',%.,-„..-4-,4; .V:.:'''..''',':-.• •,- ,,':`,...!,..V.'.,',:•).V4.'::?-: ,'.!,, 0."''''r li°;.'-'.1. ; .•'V '-,-,•,'17 , :.,_‘ ," "12, ',.. '•;'tr.1'' '''''',7,if;'le-T..'":•',..7-Ekg,'" r'••-.'"..3,',',.:rsz.,,,,,T.,•;:.;',..,':'.:'2•-•,'.:.-y.j,t..t.. '",,,::]:::i.;:'•',•.,:-. ..,,,,,,- ,. : •t4„*..:.,':,,,i.,.:e,;:„..; •,-.,.?,..r..:,•,,",::::„:t4.....„,s,,,14.f, ,,, , ., .:,,',..,,,,7,...-Ii•• •:: :,,, .„ ,r...!...-,,irr,,,?.... i...'. .-,f4,.:;..-,•;:"4:1* : c4,*i4-4.:*..W40.t4,,-aVrix"-‘...1:4...--,i,...:-.4v.x40- .;-::,.t.,,,,,:mi,(:, ..,.:;;4,1,.4..,.;,:ir::,..4. ,..,-,3v.x:.,,t::,,,...:•:.N,,,I,-. .....,,,,,...:,..,.,, ..,4,,....„. .,,,,„,,‘.. ,......,,,,..,4,..,„ , ,,,,, : 4 .,„.„:, ,,„,,,,, ,, _„,,,„, ...,, , ,,,,,,,,„„,,„,„„„,,,,.,.,.:..„,„:„ :„:„. ...:,„„.v...,,: : ..:„,„..„,,,:..,,,,,„,,..„.„.„,-......,,,,„.„,,::,..,::,,,..:,,,,„,:,,,„.:.„,„,,,,,„,,,,,,,,..,,,,,,,‘„,„„),,-,..,,,,,-„,,,:,),..,,,.....,,,,,-, .,,,,„,..,,,,,,,,,.. ,,,,,,:::",„.:,...,.„.:4,,,,,,..„..,,,,,,,,,,,,,,,,,...„.„,.,,,,,,..,,,:„,„,,,s,„.,,,„:„,...„:„.„,,,:.,,,,,,,.„,,,,.,„:„,,,:,,,,,„„:„.7„,,,,,::,,,,:—„,:- . -..,,,,,„,.„_....„.,,,,„,„,,,,.,3,„f,, ,..,,,,.,- ,,,,,,,,„,,,,,,„„:„.,,,., ..,,,,,,,,,,...„,„ .„.,f-P,'-',7Ai:4:t%;.::...:Vi.:6%k,„:p!-, A...,. 4: :!,441.;:ksi.M?:n .: ::.::1;';:.:'!2'..,' ',,,, 'i',:7i'4'.'.'°.-,,,,;-''.0...,',...t,,l„:.,,'!'4:,,-,p*/.!is.'%'''':,'.'',.k;,,:'''''.',..,;'.,,t,,,,.•,.:,,*"'..'4",'4, '''4,''!:4..-•.(.,:J"*.----'-.,,Ig.1'....;.2 ;I-,4...''':.'?''':,;,.,',3,,,7,%,,•,-'.a!,..:,„:.:,.,.:,g...;!;.;';:.'.;;.::7::"c:4:::,1.:1.,0.i!•:i::,..':''','i,., ::..,.. :4i -.,,"ol•,',. t.;,'-.,.*,:g.!:':A•.::.'.:...,::.:!:,:i';'.LE:ii,.',G..?M;.&A L NA::.;.ME .'. v ,, .e14; 7i ‘ . 5T4 , '., ',4,--4014,,',fe.4% '-'3.':-.:" 'N''.*;'---',/i47':."::,::,.*.j,.•,5,,,J.,A:J7 ::,,,-:,.,,,,:..:.,c-::::. -. ,--,,, ----4---.: :;:,,,,i,:-.:,!...•:,:,,v-,:i-y--,;-::- ..x- ;*----:;.::-:.:-: :444:ite.. .•,:ii:$4ei*.k.-:.-7,:t. ,'•.,.‘ -,,,,, ,.- 'si,.7,3,,•,i,,4*4.„..*:'. , ,"' •4 ttt .-:!,1;..'*.-e. ' APODACA, GILBERT ,,,, . .._., , , .... „A CALIFORNIA TRAFFIC MAINTENANCE .,•,,,,, ..., -.".,-,f- ,. ..r„, ..,---..• :;,,, A..:,b,, .., • , .. ,,...,:. P 1 1731 N. CALIFORNIA ST. :' K.,,,,,, ••- -- •.... i.• ..,.-p: ...,,,,...; f-,1*.,:...,,,,,,T.., ' ' '' ,,---'-':.',f'-'-,.. ---..-- -*.-, ,,-rev-',CA”,t",71/4, C''''.%-'',,(f•l•-as,,, ,:,, ,- ,L, -,•••-, BURBANK CA 91505 , rx,-- 1","-.7"":. "`7 'V:,(,`" ':''"7"70' r•°. ft 77 1•,' , s;',7,',`,'' 7','""'"7"- ' '''--,-'''''',W ' •'''-', '''' '.' ' ' - ''''''.' ''. ;7'."-,1:,,•, ''.••-.",'•;e",,,t• ';'",,,`;,;•Ak-i,,,,,4 v ,,, -,,,,,,_,i, „,., ';',-;„.•;" 77,.%•',7,,,••••* 4,; ,"4. .". ,t` .:;;Zi,' •,' 7 .,' .•7 -4, -"tt. '•"7:Aft, '4'' N","flt''''.e',a,,,'4,""=, ,-',.- .,„„ '", .*1-717 -j -, -7-,•- •1,.;$,,‘ ''''''''' . ' -• - - - ' '' '- r.,,... :•Fp•4_ 4V;""'.-' -'7'' ,,e,„-i.,,,,54,10., i-'6tr,l'ICIP'04.t..4.1-::":. ,,'. . ,;4..,,,,*'-i ,,- . „:6,.... ,..,..%, : „"*. ,,,,,-0,•...,,,,,,,,,,:.:„.7.,,,,,,,„:04a,..,,t4,..,.,4..,;,:. * -,,,-,"-q-.. ,„7e41. .114,•,:."° '''''7 '1' '''$'''1''' '''-'1'' ''',''-',!--:':,-'1''' ' '''-''''''''I''-'7 PRINTED: 12-18-98 P0408 .: SCIF 10265(REV.2-95) THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND 0111 yo) 32400 PASEO ADELANTO MEMBERS OF THE CITY COUNCIL JOHN SAN JUAN CAPISTRANO,CA 92675 . JO NGECAMPBELL � REINER (949)493-1171 �' IAIOAIOAAIII WYATT HART ES (949)493-1053 (FAX) ' tom. 1961 DAVIDGIL 176 DAVID M.SWERDLIN • I', • CITY MANAGER �� GEORGE SCARBOROUGH • December 10, 1998 Mr. Gilbert Apodaca California Traffic Maintenance 1731 N. California Street Burbank, California 91505 Re: Renewal of Workers' Compensation Certificate of Insurance (Pavement Marking Maintenance, Installation and Removal) Mr. Apodaca: The Workers' Compensation Certificate of Insurance,regarding the above-referenced service,is due to expire on January 1, 1999. In accordance with your agreement,the insurance certificate needs to be renewed for an additional period of one year. Please forward an updated certificate to the City of San Juan Capistrano, attention City Clerk's office, by January 1, 1999. If you have any questions, please contact me at (949) 443-6310. Thank you for your cooperation. Very truly yours, /00-Or? . d / /' Dawn M. Schanderl Deputy City Clerk cc: Cheryl Johnson, City Clerk Silvia Cintron, Public Works DRUG USE IS AB San Juan Capistrano: Preserving the Past to Enhance the Future