1993-0517_BOTACO, INC._Workers' Comp Insurance0
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STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMrINSATION
1 N 5 U R A N C C
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
MAY 17, 1993 POLICYNUMBER:1332443 — 93
CERTIFICATE EXPIRES: 1-1-94
CITY OF SAN JUAN CAPISTRANO
ATTENTION: CITY CLERK
32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
THIS SUPERSEDES AND
CORRECTS THE CERTIFICATE
ISSUED ON 04-21-93.
JOB: ALL OPERATIONS
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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 poli3y0
period indicated.
This policy is not subject to cancellation by the Fund except upon yep days' advance written notice to the employer.
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We will also give you TAXI 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
policies 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 may pertain, the insurance afforded by the policies
described herein is subject to all the terms, exclusions and conditions of such policies. vf�
X.
PRESIDENT
EMPLOYER'S LIABILITY LIMIT: $3,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE
04/21/93 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
F—
BOTACO, INC. AND/OR BOTA PACIFIC INC.
DBA: BOTACO/BOTA PACIFIC
31921 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO, CA 92675
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SCIF 10262 (REV. 10-86)