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7/17/13 <br />Washington State Department of <br />Labor and Industries <br />Verify Workers' Comp Premium Status - Employer Liability Certiicale <br />Department of Labor and Industries <br />Employer Liability Certificate <br />Date: 07/17/2013 <br />UBI #: 603 093 734 <br />Legal Business Name: ERVIN LO VETT & MILLER INC <br />Account #: 218,363 -00 <br />'Doing Business As' Name: ELM INC <br />Estimated Workers Reported: Quarter 2 of Year 2013 "0" Workers <br />(See Description Below) <br />Employer Liability <br />Certificate <br />Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid <br />their premiums. <br />Licensed Contractor? No <br />Account Representative: T3 / TIMOTI --IY LUNDIN (360)902 -5240 - Email: <br />LUNL235 @h.wa.gov <br />What does "Estimated Workers Reported" mean? <br />Estimated workers reported represents the number of full time position requiring at least 480 hours of <br />work per calendar quarter. A single 480 hour position may be filled by one person, or several part time <br />workers. <br />Industrial Insurance Information <br />Employers report and pay premiums each quarter based on hours of employee work already <br />performed, and are liable for premiums found later to be due. Industrial insurance accounts have no <br />policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW <br />51.12.050 and 51.16.190). <br />1'PECt3V t AS 'TO E4)i:t�i <br />as�rs[ani ?..Y All"—c,. <br />https: / /fortress.w .g ovAni /crpsi /AcctlnfoPri nt.aspr ?Accountld= 21836300&AccountM anag er= T3 + %2f +TIMOTHY +LU N DIN +(360)902- 5240 + - +Email / 3a +LU N... 1/1 <br />