Laserfiche WebLink
<br />Au.-31~200G 10:22a1 FrQl-OCBF +714-480-1933 <br />WORKERS COMPENSATION AND EMPLOYERS LlABJL1TY INSURANCE POlley <br /> <br />T-3~C P 005/00i F-236 <br />we 00 00 01 A <br /> <br />:. <br /> <br />Virginia Surety Company <br /> <br />EXTENSION OF INFORMATION PAGB <br />SCHEDULB OF PA YMBNTS <br /> <br />POUCYNO :---', <br />VSQSWP )()()7046 00 1 <br />, <br />__~.---.J <br /> <br />PAYMENT PLAN : 15" down & 9 iDsrallmc:ms <br /> <br />Bill Date. J)aeriplioa Bill Alnount <br />O]1OSflOOfj Premium Amouat $ 1,371.00 <br />011OSllOO6 A-mmcmts $ 236.00 <br />0210112006 PremIum Amount S 911.00 <br />0210112006 lDstalbneat Fee S 7.00 <br />0310 112006 PrCinium Amount $ 854.00 <br />03/0 lflOO6 '-llment fee s 7.00 <br />0410112006 Pmnimn .AD1olmt s 854.00 <br />0410 llZOO6 T_l1mentl'ee S 7.00 <br />OSI01!2006 Pranium Amo1mt s 854.00 <br />OSlO1IlOO6 IDstaUme.nc Pee $ 7.00 <br />06101/2006 Pr=hm Amount , 899.00 <br />0610112006 JnmRr-nt Fee s "700 <br />0610112006 Assessments s i.OO <br />07/0112006 Premium Amount s 899 .00 <br />07101.12006 Jp.....l1m"Qt Fee s 7.00 <br />07/0112006 .AsscssmenI:$ $ 1.00 <br />Ol/DlflOO6 Pnmtiwn Amount s 899.00 <br />081011.2006 lDstaUmcmt Fee s 7.00 <br />0810112006 Assessmeots s 1.00 <br />09/01J2006 Premium Amount $ 899.00 <br />09/0112006 IDstallmtmt Fee s 7.00 <br />0910112006 ~mlS s 1.00 <br />1010]12006 Premium Amomrt s 899.00 <br />.-.. ....... - <br />1 OJO 112006 Imml-"-"'r Fee $ 7.00 . <br />10lOJI2OO6 Assessmeats s LOO <br /> <br />.f <br /> <br />vsc-wc..INm <br />