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2019/06/25 ND Construction Company, Inc. Certificate of Workers' Compensation Insurance- Cancellation NoticeSEPTEMBER 10, 2019 MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 CITY OF MENIFEE FINANCE EP 13 2010 RECEIVED IN REPLY REFER TO: CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION NOTICE ------------------- RE: CERTIFICATE DATED JUNE 25, 2019 THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW WILL BE CANCELLED EFFECTIVE OCTOBER 16, 2019 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: ND CONSTRUCTION COMPANY, INC. 2201 E WINSTON RD STE M ANAHEIM, CA 92806 POLICY 1066062-19 POLICYHOLDER SERVICES SPECIALTY OPERATIONS DISTRICT OFFICE (925) 523-5199 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 SCIF 19102 City of Menifee Finance �LI" � ,r E(1s�� SEPTEMBER 9, 2019 Received MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 IN REPLY REFER TO: CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION WITHDRAWAL NOTICE ------------------------------ RE: CERTIFICATE DATED JUNE 25, 2019 THE CANCELLATION HAS BEEN WITHDRAWN FOR THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW. THIS LETTER SUPERSEDES THE NOTICE OF CANCELLATION SENT TO YOU ON AUGUST 1, 2019. THIS EMPLOYER'S WORKERS' COMPENSATION INSURANCE COVERAGE CONTINUED UNINTERRUPTED. REP D1 EMPLOYER: ND CONSTRUCTION COMPANY, INC. 2201 E WINSTON RD STE M ANAHEIM, CA 92806 POLICY 1066062-19 POLICYHOLDER SERVICES SPECIALTY OPERATIONS DISTRICT OFFICE (925) 523-5199 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 SCIF 19102 CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-19-2019 EN�fEE GROUP: roppµCE POLICY NUMBER: 1066062-2019 CERTIFICATE ID: 321 SUN Z 6 2�19 CERTIFICATE 01-01-20 9/06-27-2019 CITY OF MENIFEE RECEIVES SP 29844 HAUN RD MENIFEE CA 92586-6539 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 that will expire or did expire as indicated above. 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 #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-01-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF MENIFEE ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2016 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - MICHAEL MARTIN PRESIDENT - EXCLUDED ENDORSEMENT #1651 - LINDA MARTIN SECRETARY - EXCLUDED. EMPLOYER ND CONSTRUCTION COMPANY, INC. 2201 E WINSTON RD STE M ANAHEIM CA 92808 SP M0408 (REV.7-2014) PRINTED : 06-20-2019 CITY OF MEFINANCE FEE 6W%=2019 AUGUST 1, 2019 RECEIVED MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION NOTICE ------------------- RE: CERTIFICATE DATED JUNE 25, 2019 IN REPLY REFER TO: THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW WILL BE CANCELLED EFFECTIVE SEPTEMBER 6, 2019 AT 12:01 A.M. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE EMPLOYER NAMED BELOW EMPLOYER: ND CONSTRUCTION COMPANY, INC. 2201 E WINSTON RD STE M ANAHEIM, CA 92806 POLICY 1066062-19 POLICYHOLDER SERVICES SPECIALTY OPERATIONS DISTRICT OFFICE (925) 523-5199 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 SCIF 19102 CERTHOLDER COPY SP ISSUE DATE: 06-25-2019 MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE SP GROUP: POLICY NUMBER: 1068062-2019 CERTIFICATE ID: 330 CERTIFICATE EXPIRES: 01-01-2020 01-01-2019/01-01-2020 City of Menifee Finance 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 #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-08-25 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: MENIFEE ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2016 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - MICHAEL MARTIN PRESIDENT - EXCLUDED. ENDORSEMENT #1651 - LINDA MARTIN SECRETARY - EXCLUDED. EMPLOYER ND CONSTRUCTION COMPANY, INC. 2201 E WINSTON RD STE M ANAHEIM CA 92806 SP M0408 (REV.7-2014) PRINTED : 06-26-2019 JUNE 25, 2019 CITY OF MENIFEE 29844 HAUN RD MENIFEE CA 92586-6539 IN REPLY REFER TO: city of Menifee Finance ymi 2 8 2,111, Received CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION WITHDRAWAL NOTICE -------- ---------------------- RE: CERTIFICATE DATED JUNE 19, 2019 THE CANCELLATION HAS BEEN WITHDRAWN FOR THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER NAMED BELOW. THIS LETTER SUPERSEDES THE NOTICE OF CANCELLATION SENT TO YOU ON MAY 22, 2019. THIS EMPLOYER'S WORKERS' COMPENSATION INSURANCE COVERAGE CONTINUED UNINTERRUPTED. REP D1 EMPLOYER: ND CONSTRUCTION COMPANY, INC. 2201 E WINSTON RD STE M ANAHEIM, CA 92806 POLICY 1066062-19 POLICYHOLDER SERVICES SPECIALTY OPERATIONS DISTRICT OFFICE (925) 523-5199 5860 Owens Dr Pleasanton, CA 94588-3900 Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682 SCIF 19102