2019/07/01 Barr & Clark, Inc. Certificate of Workers' Compensation InsuranceCERTHOLDER COPY SP
4
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 07-01-2019 clyoft GROUP:
F1111 POLICY NUMBER: 1917813-2019
CERTIFICATE ID: 207
CERTIFICATE EXPIRES: 07-01-2020
JUI. 07-01-2019/07-01-2020
CITY OF MENIFEE RECE�u D
29714 HAUN RD
MENIFEE CA 92586-6540
SP CITyV01F M EIFEE
IlIkIlJul. o 120
RECEIVED
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 #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2010 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
BARR & CLARK, INC
16531 BOLSA CHICA ST STE 205
HUNTINGTON BEACH CA 92649
SP
M0408
(REV.7-2014) PRINTED : 06-17-2019