2020/09/01 Arroyo, Eric and Arroyo Terisia Certificate of Workers' Compensation Insurance SP
ISSUE DATE: 11-16-2020
1863950-2020
33
09-01-2021
09-01-2020/09-01-2021
CITY OF MENIFEE SP
29844 HAUN RD
MENIFEE CA 92586-6539
30
30
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 09-01-2012 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
Arroyo, Eric (and) Arroyo, Terisia SP
19510 VAN BUREN F-3-192
RIVERSIDE CA 92508
PRINTED : 11-16-2020
POLICYHOLDER COPY
[P19,SK]