Laserfiche WebLink
Page 4 <br />Named Insured BACKHAUS DANCE <br />Customer ID <br />Policy Number WC80946 <br />Transaction Type New Business Effective <br />WORKERS COMP POLICY INFORMATION RECAP <br />Predominant State: <br />CA <br />Employers Liability: <br />Each Accident: <br />Policy Limit: <br />Each Employee: <br />Admiralty Limit: <br />Per Accident: <br />Program Type: <br />FELA Limit: <br />Per Accident: <br />Program Type: <br />Retro Plan: <br />No <br />Interstate Exper Mod ID: <br />Effective Date: <br />Exper Mod: <br />Minimum Premium Term/Trans <br />Policy: 1590 <br />Empl Liab: 120 <br />Admiralty: <br />FELA: <br />Combined Policy Premium: <br />NJ Premium: <br />Executive Officers: No <br />Employee Leasing: No <br />Deposit Factor: <br />Installment Plan: 11 <br />Highest Per Policy <br />1590 <br />120 <br />1,000,000 <br />1,000,000 <br />1,000,000 <br />N/A <br />N/A <br />N/A <br />N/A <br />9/7/2021 <br />oRaN <br />Ii:AMamaganentDMsian <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />