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Invoice Number: 37111 <br />CLIENT #: 29878 <br />Due Date: DUE UPON RECEIPT <br />Total amount due: $318.66 <br />Remit To: OD28706 <br />Amount of remittance: $ <br />E.L.M. Insurance Brokers, Inc. p <br />D <br />P.O. Box 2668 <br />1990 E. Grand Ave Ste 210 Ca Lic OD28706 <br />EI Segundo, CA 90245 -1768 <br />Please return this portion with payment <br />Invoice Date: JUL 3 07 (Unposted) <br />Type: A <br />Invoice # 37111 <br />Trans <br />Code <br />Coverage <br />Eff Date <br />Policy# <br />Line of Business <br />Description <br />Amount <br />RE <br />JUN 28 07 <br />0608- 00067145D <br />Arbitrators & Me <br />Lloyds E &O Renewal <br />$309.00 <br />ST <br />JUN 28 07 <br />0608- 00067145D <br />Arbitrators & Me <br />SL Tax @ 3% <br />$9.27 <br />SF <br />JUN 28 07 <br />0608- 00067145D <br />Arbitrators & Me <br />SL Fee @.125% <br />$0.39 <br />E.L.M. Insurance Brokers, Inc. <br />P.O. Box 2668 <br />1990 E. Grand Ave Ste 210 Ca Lic OD28706 <br />El Segundo, CA 90245 -1768 <br />PHONE: 310 - 322 -1301 <br />Betsy Benton <br />422 W. Santa Clara Avenue <br />Santa Ana, CA 92706 <br />FAX: 310- 322 -1302 <br />TOTAL AMOUNT DUE: $318.66 <br />Ins, <br />i <br />EXECUTIVE LIABILITY {MANAGERS <br />INSUORCE BROKERS <br />