1999-0301_CALIFORNIA TRAFFIC MAINTENANCE_Workers' Comp Canceled STATE
COMPENSATION
INSURANCE RECEIVED
FUNDIFR 29 I tis 199 IN REPLY REFER TO:
MARCH 17 , 1999 CITY Ct `ftK J
DC r'Ai T MCNT
CITY CF SAN
JUAN (WIS.. HANG
CITY OF SAN CAPISTRANO
ATTN: CITY CLERK' S OFFICE
32400 PASEO
ADELANTO
CA 92675
CERTIFICATE OF WORKERS'
COMPENSATION INSURANCE
CANCELLATION NOTICE
RE: CERTIFICATE DATED JANUARY 25 , 1999 .
THE WORKERS ' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER
NAMED BELOW HAS BEEN CANCELLED EFFECTIVE MARCH 1 , 1999 AT
12: 01 A.M.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE
CONTACT THE EMPLOYER NAMED BELOW
EMPLOYER:
TRAFFIC MAINTENANCE
1731 N. CALIFORNIA ST.
BURBANK
CALIF. , 91505
046-99 UNIT 0007629
POLICY SERVICES
ee.° stivietWOODLAND HILLS DISTRICT OFFICE
( 818 ) 888-4750
3/2aseVor ftAJ
41001
1 275 Market Street • San Francisco, CA 94103-1410
Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807
SCIF 19102
r .
STATE
COMPENSATION RECEIVED
INSURANCE
FUND PInR 29 2 44 I 'I '99 IN REPLY REFER TO:
L:;'; CLERK
MARCH 17 , 1999 DEt!:R1!r1ENT
CI.rY OF SAN
JUAN CAPIS i Rr;Nt1
CITY OF SAN JUAN CAPISTRANO
ATTN:DEPUTY CITY CLERK,DAWN SCHANDERI
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO
CA 92675
CERTIFICATE OF WORKERS '
COMPENSATION INSURANCE
CANCELLATION NOTICE
RE: CERTIFICATE DATED JANUARY 1 , 1999 .
THE WORKERS ' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER
NAMED BELOW HAS BEEN CANCELLED EFFECTIVE MARCH 1 , 1999 AT
12: 01 A.M.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE
CONTACT THE EMPLOYER NAMED BELOW
EMPLOYER:
CALIFORNIA TRAFFIC MAINTENANCE
1731 N. CALIFORNIA ST.
BURBANK
CALIF . , 91505
046-99 UNIT 0007629
POLICY SERVICES
WOODLAND HILLS DISTRICT OFFICE
( 818) 888-4750
1 275 Market Street • San Francisco, CA 94103-1410
Mailing Address: P.O. Box 420807 • San Francisco, CA 94142-0807
SCIF 19102
PAGE 01
02/33/1999 13:47 818-954-5266
1731 N ^.aiitomia Si , &Ater x,Ca 91505,Phone(818)954-8271,
Fax(81£)x54-9268 California Traffic
Maintenance
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Fax : MIR 3 0 1999
Yo: S'a i V t'<7t Prom K et,i'
Fax: C c 149 l tt of `` 311 sS posoto Z
Re: CC:
0 Urgent Ots\f or Review 0 Maas Conmatirit 0 Please Reply 0 Please ReCycie
e Comn k1ts: