Laserfiche WebLink
Page 2 <br />TERM STATE TOTALS <br />State <br />CA <br />Estimated Totals <br />Named Insured BACKHAUS DANCE <br />Customer ID <br />Policy Number WC80946 <br />Transaction Type New Business Effective <br />Exposure <br />86,005 <br />86,005 <br />9/7/2021 <br />Estimated <br />Taxes And <br />State <br />Premium <br />Assessments <br />Total <br />5,637.00 <br />224.00 <br />5,861.00 <br />5,637.00 <br />224.00 <br />5,861.00 <br />oRaN <br />Risk Mwag merdDMsian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />