Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 57 <br />Number of Days <br />Name of Person(s) or Entity(les) Malling Address: Advanced <br />Notice of <br />Cancellation: <br />All other terms and conditions of the Policy remain unchanged. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless <br />otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to <br />preparation of the policy.) <br />Endorsement Effective 10-01-2016 Policy No. RWD5000148-09 Endorsement No. <br />Insured Acco Engineered Systems, Inc. Premium Included <br />Insurance Company Countersigned by <br />XL Insurance America, Inc <br />WC 99 06 57 <br />Ed. 12/10 © 2010 X.L. America, Inc. All Rights Reserved. <br />May not be copied without permission. <br />REVIEWED BY: _ EUNICE HEREDIA (Pe -70F ) <br />