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Page 7 <br />Named InsuredBACKHAUS DANCE <br />Customer ID <br />Policy NumberWC80946 <br />Transaction TypeNew BusinessEffective9/7/2021 <br /> <br />Tdifevmf!Npejgjdbujpo <br />Name of InsuredBACKHAUS DANCEDate09/02/2021 <br />Special NotesDANCE EDUCATION THROUGH A <br />Policy NumberWC80946Agy/Prod NameAutomatic Data Processing Insurance Agency, Inc. <br />Client NumberOperatorJACK SPIVEY <br />Insurance CoSirius America Ins Co <br />Line Of BusinessWK <br />Subline* <br />Effective Date09/07/2021Expiration Date09/07/2022 <br />Policy Term1 Year <br />State(s)CA <br />Trans TypeNew Business <br />Tdifevmf!Npejgjdbujpo <br />Sjtl!DibsbdufsjtujdDsfeju0Efcju <br />Employees-Selection, Training, Supervision0.91 <br />JustificationFORMAL WRITTEN SAFETY TRAINING IN PLACE <br />Total Mod0.91 <br />FOE!PG!XPSLTIFFU <br />