HomeMy WebLinkAboutCOI - Empowering Our Community for Success - Expires 2023-10-30STATE
COMPENSATION
INSURANCE
FUND
IN REPLY REFER TO:
OCTOBER 13, 2023
CITY OF GILROY
7351 ROSANNA ST
GILROY CA 95020-6141
CERTIFICATE OF WORKERS'
COMPENSATION INSURANCE
CANCELLATION NOTICE
RE: CERTIFICATE DATED SEPTEMBER 20, 2023
THE WORKERS' COMPENSATION INSURANCE POLICY FOR THE EMPLOYER
NAMED BELOW WILL BE CANCELLED EFFECTIVE OCTOBER 30, 2023 AT
12:01 A.M.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE
CONTACT THE EMPLOYER NAMED BELOW
EMPLOYER:
EMPOWERING OUR COMMUNITY FOR SUCCE
1711 WARBURTON AVE APT 5
SANTA CLARA, CA 95050
POLICY 9261123-23
CUSTOMER SERVICE REPRESENTATIVE
CUSTOMER SERVICE CENTER
(888) 782-8338
5860 Owens Dr Pleasanton, CA 94588-3900
Mailing Address: P.O. Box 8192 • Pleasanton, CA 94588-9682
SCIF 19102