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'1117113 <br />Washington State Department.ot <br />Labor and Industries <br />Employer UnbIlItyCsrufloats <br />Department of Labor and Industries <br />Employer Liability 'Certificate <br />Date: 07/1.7/2013 <br />UBI#. 603 093 734 <br />Legalgusihoss Name: ET2VIN L.OVETT'& MILLER INC, <br />Account #.- 218,363 -00 <br />'Doing Biziness As' Name; EL I IINC. <br />Estimated Workers Reported: Quarter 2 of Year 2013 "0" Workers <br />(See DescriptionBetow) <br />Employer Liability <br />Cortifieate <br />WOvkers' Comp Pr iumStaturs; Account is curent.Firrtuhas voluntarily reported and paid <br />their premiums. <br />Licensed Contractor? No <br />Account Representative: T3 / T MOTIIY L,IJNDIN (360) 02 -5240 - Email: <br />U NL235 @ldwa.gov <br />What does t Fstinrated Wovlwrs Reported" meant'' <br />Estimated workers reported represents the number of Ibil tinge positibt`a requlriag at least 480 hours of <br />work per calendar quarter. A single 480 hour poshicrnrnay be filled by one person, or seeerat part time <br />workers. <br />Industrial Irs urance Information <br />Employers report and pay premiums each quarter based on hours of employee work already <br />perbrmed, and are liable fbr premiums found later to be due. Industrial insurance accounts have no <br />Policy periods, cancellation dates, limitations of coverage- or waiver of subrogation (See RLE <br />51.12;0_5Q and.iL L6 91), <br />tL'iFLi)ve AS Iib l'O €�wi <br />ahaeSUl ry� Ci'xr- �tr�ir �'�'- <br />hues;/[ f0rveww,, g0vlWorpail kotl eo T3 + 1/.?.f�TtMQTFIY +IUN0 IN +000)@02.524Gf —h Mafl%34+LU N,,, <br />111 <br />