Laserfiche WebLink
<br />(Policy Provisions:WC000000C) <br />INFORMATION PAGE <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY <br />INSURER:SEE ATTACHED ENDORSEMENT <br />20621 <br />NCCI Company Number: <br />Company Code:9 <br />Ejhjubmmz!tjhofe!cz!Bohjf!Bdfwfep! <br />Bohjf!Bdfwfep <br />Ebuf;!3135/21/12!25;36;51!.18(11( <br />Suffix <br />LARSRENEWAL <br />76WEGAZ6AMU2 <br />POLICY NUMBER: <br />76 WEG AZ6AMU <br />Previous Policy Number: <br />BEGINNERS EDGE SPORTS TRAINING <br />1.Named Insured and Mailing Address: <br />7432 E TIERRA BUENA LN <br />(No., Street, Town, State, Zip Code) <br />SCOTTSDALE AZ85260 <br />FEIN Number:26-2932264 <br />Refer to the EXTENSION OF THE INFORMATION PAGE – WC990365. <br />State Identification Number(s): <br />The Named Insured is:LLC <br />Business of Named Insured:Fitness and Recreational Sports Centers <br />Other workplaces not shown above:See Endorsement - WC990366 <br />2.Policy Period:From09/26/24To09/26/25ANNUAL <br />12:01 a.m., Standard time at the insured's mailing address. <br />Producer’s Name:PAYCHEX INSURANCE AGENCY INC/PHS <br />225 KENNETH DR STE 110 <br />ROCHESTER NY 14623 <br />Producer’s Code:76210690 <br />THE HARTFORD BUSINESS SERVICE CENTER <br />Issuing Office: <br />3600 WISEMAN BLVD <br />SAN ANTONIO TX 78251 <br />(877) 287-1312 <br />$2,133 <br />Total Estimated Annual Premium: <br />Deposit Premium: <br />$600CA (Includes Increased Limit Min. Prem.) <br />Policy Minimum Premium: <br />Installment Term: <br />Audit Period:ANNUAL <br />The policy is not binding unless countersigned by our authorized representative. <br />08/17/24 <br />Countersigned by <br />Authorized RepresentativeDate <br />Form WC 00 00 01 A(1)Printed in U.S.A.Page 1(Continued on next page) <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />