2010/11/01 Becker Engineering Certificate of Workers' Compensation InsuranceCERTHOLDER COPY
SO
ISSUE DATE: 11-01-2010
CITY OF MENIFEE
29714 HAUN RD
SUN CITY CA 92586-6540
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
U 1 L 2010
BY:
SO
GROUP: 000467
POLICY NUMBER: 0025035-2010
CERTIFICATE ID: 13
CERTIFICATE EXPIRES: 11-01-2011
11-01-2010/11-01-2011
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.
VA�4-t
tth,r,zed Representative Interim President and CEO
UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING:
THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER;
EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING
CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS'
COMPENSATION LAW.
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-01-2010 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
BECKER, WALTER K. DBA: BECKER ENGINEERING SO
PO BOX 890365
TEMECULA CA 92589
[CAA,CS]
(REV.1-2010) PRINTED : 10-26-2010