1997-0901_PETAR ARTUKOVICH CONSTRUCTION_Workers Compensation STATE P.O. BOX 420807,SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
JUNE 3 , 1997 1446762 - 96
POLICY NUMBER:
CERTIFICATE EXPIRES: 9-1-9 7
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CITY OF SAN JUAN CAPISTRANO
DEPT OF BUILDING AND SAFETY
32400 PASEO ADELANITO
SAN JUAN CAPISTRANO, CA 92675 JOB : INSURANCE VERIFICATION
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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 policy period indicated. _
This policy is not subject to cancellation by the Fund except upon ten days'advance written notice to the employer.
We will also give you TEN 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.
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AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER' S LIABILITY LIMIT INCLUDING DEFENSE COSTS : $1 , 000 , 000 PER OCCURRENCE
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EMPLOYER
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PETER ARTUKOVICH CONSTRUCTION CO. , INC.
8243 SERANATA DR
WHITTIER CA 90603
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262(REV.3-95)