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9% 0�� .......... 1 1 <br />1 <br />CRC - Santa Ana <br />Pay Online: https://apps.crcgroup.com/pay <br />PO Box 95236 <br />Grapevine, TX 76099-9752 <br />Accounting Customer Service Number 1 844-630-0089 <br />Accounting Site: https://www.crcgroup.com/More/Accounting <br />Bill To: AGT25124 Attn: Richard Campoli <br />Elmco Insurance Inc. Submission No: 10148240 <br />1905 N Main Street <br />Santa Ana, CA 92706 <br />AB <br />Agent: <br />CSR: Dennis Martirez Jr. <br />Producer: Joshua Katcef <br />AGT25124 <br />dmartirez@crcgroup.com <br />JKatcef@crcgroup.com <br />INVOICE <br />Invoice Date: <br />Invoice Number: <br />Page: <br />06/21 /2022 <br />4812664 <br />1 <br />Insured: California Barricade Rentals, Inc. <br />INVOICE PAYMENT <br />Payment Due On: 07/21/2022 <br />DBA: <br />Insurance Company: <br />Policy Number: <br />Effective: <br />Expires: <br />Trisura Specialty Insurance Company <br />TXS0001452-03 (REN: TXS0001452-02) <br />07/01/2022 <br />07/01/2023 <br />Type of Transaction <br />Renewal Business <br />Line of Business <br />EXCESS LIABILITY <br />Comp ID <br />M4024 <br />Amount <br />$25,500.00 <br />Comm($) <br />$2,550.00 <br />Net Due <br />$22,950.00 <br />Broker Fee <br />EXCESS LIABILITY <br />IRVN <br />$700.00 <br />$0.00 <br />$700.00 <br />Company Policy Fee <br />EXCESS LIABILITY <br />M4024 <br />$250.00 <br />$0.00 <br />$250.00 <br />Surplus Lines Tax <br />EXCESS LIABILITY <br />CATAX <br />$772.50 <br />$0.00 <br />$772.50 <br />Stamping Office Fee <br />EXCESS LIABILITY <br />CASOF <br />$64.38 <br />$0.00 <br />$64.38 <br />Amount Invoiced: <br />Comm % <br />Commission <br />Total Net Due <br />$ 27,286.88 <br />10.00 <br />$ 2,550.00 <br />$ 24,736.88 <br />Note: <br />RAMuaigmadDlMsian <br />E <br />REVIEWED & APPROVED BY. <br />e Aeevaa <br />Agency Bill er RfskManagement Specialist <br />