My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
JENNIFER BACKHAUS DBA BACKHAUS DANCE
Clerk
>
Contracts / Agreements
>
J
>
JENNIFER BACKHAUS DBA BACKHAUS DANCE
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/17/2021 11:06:22 AM
Creation date
12/16/2021 4:53:10 PM
Metadata
Fields
Template:
Contracts
Company Name
JENNIFER BACKHAUS DBA BACKHAUS DANCE
Contract #
N-2021-250
Agency
Parks, Recreation, & Community Services
Expiration Date
12/31/2022
Insurance Exp Date
6/3/2022
Destruction Year
2027
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
235
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
QPMJDZ!EFDJTJPOT <br />Qjf!Jotvsbodf!Ipmejoht!Jod/ <br />2126!26ui!Tusffu!OX-!Tvjuf!711 <br />Xbtijohupo-!ED!31116.3716 <br />SBUJOH!XPSLTIFFUT <br />Named Insured:BACKHAUS DANCEDate:09/02/2021 <br />Special Notes:DANCE EDUCATION THROUGH A <br />Agy/Prod Number:1850 <br />Policy Number:WC80946Agy/Prod Name:Automatic Data Processing Insurance Agency, Inc. <br />Client Number:OperatorJSPIVEY <br />System Assign:08209400000000 <br />System Release:21.04 <br />Business Type:Non-Profit <br />Insurance Co:Sirius America Ins Co <br />Line Of Business:Workers Comp (Voluntary) <br />Effective Date:09/07/2021Expiration Date:09/07/2022 <br />Anniversary Date:Audit Frequency:Annual <br />Policy Term:1 Year <br />Predominant State:CA <br />Transaction Type:NEW BUSINESSTransaction Sequence:001 <br />QPMJDZ!QSFNJVN!UPUBMT <br />DpwfsbhftUfsn!Qsfnjvn <br />Dmbtt!Qsfnjvn5-:2:/11 <br />Employer's Liab Premium65.00 <br />Empl Liab Min Diff Premium55.00 <br />Schedule Mod Premium-542.00 <br />Territory Factor984.00 <br />Tuboebse!Qsfnjvn6-592/11 <br />Premium Discount-55.00 <br />Expense Constant160.00 <br />Terrorism34.00 <br />Catastrophe17.00 <br />Ftujnbufe!Qsfnjvn6-748/11 <br />Taxes and Assessments224.00 <br />Ftujnbufe!Upubm6-972/11 <br /> <br />
The URL can be used to link to this page
Your browser does not support the video tag.