2017/06/01 R M Environmental, Inc. Certificate of Workers' Compensation InsuranceCERTHOLDER COPY SP
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 06-01-2017 GROUP:
POLICY NUMBER: 1519365-2017
CERTIFICATE ID: 76
CERTIFICATE EXPIRES: 06-01-2018
06-01-2017/06-01-2018
CITY OF MENIFEE SP JOB:SUN CITY SOCO (WALGREENS) WELL ABANDONMENT
26771 MCCALL BLVD
29714 HAUN RD SUN CITY
MENIFEE CA 92586-6540 CA 92381
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 2016-06-01 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
CITY OF MENIFEE
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-01-2005 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
R M ENVIRONMENTAL INC SP
PO BOX 575
CALIMESA CA 92320
PRINTED : 05-17-2017
(REV.7-2014)
M0408