HomeMy WebLinkAboutState Compensation Insurance FundCERTHOLDER COPY
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 12-10-2024
THE TOWN OF LOS ALTOS HILLS
26379 W FREMONT RD
LOS ALTOS HILLS CA 94022-2624
NA
GROUP:
POLICY NUMBER: 9104195-2024
CERTIFICATE ID: 388
CERTIFICATE EXPIRES: 06-27-2025
06-27-2024/06-27-2025
11170 MAGDALENA ROAD
LOS ALTOS HILLS
CA 94022
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 30 days advance written notice to the employer.
We will also give you 30 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 policy 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 to which it may pertain, the insurance
afforded by .the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
Authorized Representative President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-27-2024 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT #1651 - JUAN MANUEL LOZA P,T - EXCLUDED.
ENDORSEMENT #1651 - MARIA E LOZA S - EXCLUDED.
EMPLOYER
LOZA & SONS INC
1779 140TH AVE
SAN LEANDRO CA 94578
NA
M0408
(REV.7-2014) PRINTED : 12-11-2024
NA