Laserfiche WebLink
SWOONS <br /> 11/19 /2007 10 : 14 FAX X003 <br /> OV <br /> Quote Number. wcV 8000239 <br /> AmCOMP Preferred Insurance Co. Names maured: Bic BROTHERS BIG SISTERS OF <br /> P.O. Sex 98908 - A9erd: A7IN471C PACIFIC INS. (PBG) 0247010 <br /> Nmol Palm Beeth, FL 33409-MB <br /> EXTENSION OF INFORMATION PAGE <br /> CLASSIFICATION OF OPERATIONS <br /> Premium Basis Rate Per Estlmated Policy <br /> St Loc Code Cleselfidtlml Desaip1W Total EstlmBSed $100 of Tenn Premum <br /> No. Mn3al Remuneration Remuneration <br /> FL 0001 8861 CHMITASLS - PAOF688ICNAL MGgjOY8B5 $ 600, 000 1 . 56000 $ 91360 <br /> TOTAL FOR UNIT $ 9, 360 <br /> 9898 IDfPERI@7CB HOU11FICATI(N 1 . 51000 $ 4, 774 <br /> 0063 MOTION DISCOUNT 0 .02700 $ - 392 <br /> 0900 ESPBNSB CONSTANT $ 100 <br /> 9740 TERPIWSM INS ACC CBATFD LOSS 0 . 03000 $ ISO <br /> SUBTOTAL $ 4. 772 <br /> TOTAL FOR STATN $ 14, 132 <br /> TOLL peg POI.ICT $ 14 , 133 <br /> This is a quotation only and is not a binder of ineuranae Or guarantee of iosorability, and may require appr0va1 <br /> of the refnaurar. Thia quote is only valid for 30 days and is subject to change <br /> Issued Dale: 06/19/07 <br /> QUOTE ONLY AGENT <br />