Laserfiche WebLink
]1509890 <br />Wesco Insurance Company _ <br />A Stock Insurance Company <br />874 Walker Rd, Suite C <br />Dover, DE 19904 <br />WORKERS COMPENSATION WC990001 C <br />AND EMPLOYERS LIABILITY <br />INSURANCE POLICY INFORMATION PAGE <br />Ncci Code: 26135 <br />1. Insured: Policy Number: W WC3292936 <br />Immigrant Defenders Law Center (A Corp) <br />634 S Spring St. 10th Floor <br />Los Angeles, CA 90014 <br />Individual Partnership <br />Other workplaces not shown above: <br />X Corporation or <br />See Extension of Information Page <br />Federal Tax ID: 474473312 <br />Producer: <br />Risk ID: <br />AmTrust North America, Inc. <br />Renewal of: TWC3567891 <br />c/o Paychex Insurance Agency, Inc. (B) <br />150 Sawgrass Drive <br />- <br />Rochester, NY 14620 <br />2. The policy period is from 8/1/2017 to 8/1/2018 12:01 a.m. at the insured's mailing address. <br />3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed <br />here: California <br />B. Employers Liability Insurance: Part Two of the policy applies to work in each stated listed in item 3.A. <br />The limits of our liability under Part Two are: <br />State Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease <br />$ 1,000,000 each accident ✓ $1,000,000 policy limit $1,000,000 each employee <br />C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WY <br />and State(s) Designated in Item 3A. <br />D. This policy includes these endorsements and schedules: See Extension of Information Page <br />4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All <br />information required below is subject to verification and change by audit. <br />See Extension of Information Page <br />TOTAL ESTIMATED ANNUAL PREMIUM 13,351 <br />STATE ASSESSMENT 416 <br />TOTAL ESTIMATED COST 13,767 <br />Minimum Premium 500 <br />Deposit Premium 13,767 <br />Issue Date: 6/27/2017 Countersigned By: <br />Authorized Representative <br />Servicing/Issuing Office: Cleveland <br />L'� <br />