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Agmt02 County, San Mateo
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Agmt02 County, San Mateo
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Last modified
8/24/2005 12:22:11 PM
Creation date
10/21/2002 9:19:54 AM
Metadata
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Template:
Agreement
Contractor Name
County of San Mateo
PROJECT NAME
landscape maintenance Garfield School field
RMP File Number
304
Date
9/12/2002
MO Ref
02-259
Box
5969
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SPECIFIC EXCESS WORKERS COMPENSATION AND <br /> EMPLOYERS LIABILITY INDEMNITY POLICY <br /> <br /> EMPLOYERS REINSUlt,4NCE CORPORATION <br /> <br /> No. 0553087 <br /> SCHEDULE <br /> <br />1. Insured: City ofRedwood City <br /> <br />2. Mailing address: 1017 Middlefield Road <br /> R~wood City, California 94063 <br /> <br />3. Named slates: California <br /> <br />4. Excluded states: None <br /> <br />5. Policy Period: <br /> (a) From: July I, 2002 <br /> (b) To: July 1, 2003 <br /> Both days at 12:01 A~M. standard time at the <br /> Insured's address shown in Item 2 of this Schedule <br /> <br />6. Retention: <br /> (a) Each accident: $500,000 <br /> (b) Each employee for disease: $500,000 <br /> <br />7. Limit each accident: <br /> (a) Poticy Part One, Workers Compensation: $25,000,000 <br /> (b) ]Policy Part Two, Employers Liability: $ 1,000,000 <br /> <br /> 8. Limit each employee for disease: <br /> (a) Policy Part One, Workem Compensation: $25,000,000 <br /> (b) Policy Part Two, Employers Liability: $ 1,000,000 <br /> <br /> 9. Premium: <br /> (a) Payroll divided by $100 multiplied by: .2664 <br /> <br /> (b) Minimum: $110,400.00 <br /> (c) Deposit: $122,734.00 <br /> <br /> ERC-2120 I <br /> <br /> <br />
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