Laserfiche WebLink
r <br /> R <br /> G <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br /> PREMIUM DISCOUNT ENDORSEMENT <br /> 0 <br /> 0 <br /> C> Policy Number: 21 WB DU9567 <br /> Endorsement Number: 01 <br /> Ln Effective Date: 12 / 01 / 04 Effective hour is the same as stated on the Information Page of the policy. <br /> N Named Insured and Address: EXCHANGE CLUB CENTER FOR THE <br /> 0 <br /> PREVENTION OF CHILD ABUSE DBA <br /> rn PO BOX 12908 <br /> q FORT PIERCE , FL 34979 <br /> o The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. <br /> This <br /> CD endorsement shows your estimated discount in Item 1 or 2 of the Schedule . The final calculation of premium discount <br /> Co will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective <br /> * rating is not subject to premium discount. <br /> SCHEDULE <br /> State First Next <br /> Next <br /> $51000 $95,000 $400,000 Balance <br /> FL 00 . 0 % 3 . 5 % 5 . 0 % <br /> 7 . 0 % <br /> Other Policy Numbers: <br /> Countersigned by <br /> Authorized Representative <br /> Form WC 00 04 06 T Printed in U .S.A. <br /> Process Date: 01 / 26 / 05 <br /> Policy Expiration Date: 12 / 01 / 05 <br />