Laserfiche WebLink
<br /> <br />FERMA CORPORATION <br /> <br />Request for Certificate of Workers Compensation <br />State Compensation Insurance Fund <br /> <br />Page: ~ of ...!.- <br />To: Lisa - State Fund <br />Fax: (707) 455-9294 <br />Phone: (707) 455-9122 <br />or (fax) (866) 266-2071 <br />From: Rosa Rojas Lepe rrlepe@fermacorp.com <br /> <br />03/10/1 0 <br /> <br />Our Policy No. 571 - 6143-2005 <br />Fax: (650) 968-3945 <br />Phone: (650) 641-3082 or 961-2742 <br /> <br />Certificate Holder: City of Redwood City - Engineering and Construction <br /> <br />Attention: 0 <br /> <br />Address: P.O. Box 391 <br /> <br />Redwood City CA 94064 <br /> <br />Job Description: Site Demolition <br /> <br />Job Location: 1402 Maple St., Redwood City <br /> <br />Ferma Job #: 5873 <br /> <br />Customer Job #: 0 <br /> <br />Please fax to: rrlepe@fermacorp.com <br /> <br />Coverage's Required: <br />Workers Compensation Only <br />Workers Compensation with Waiver of Subrogation <br />Workers Compensation with Asbestos Endorsement <br />Will not be cancelled/expire without 30-day notice <br /> <br />Issue Only this Year <br /> <br />Issue Yearly <br /> <br />Attached Requirements from Client <br /> <br />Additional Comments: <br /> <br />If you have any questions please do not hesitate to call our office <br />Thank you for your assistance with this matter. <br /> <br />1265 Montecito Avenue, Suite 200 * Mountain View, CA 94043-4506 <br />(650) 961-2742 * Fax (650) 968-3945 <br />