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WORKERS COMPEN$AMIOITAfND,JMELOYERS LIABILITY POLICY <br />r� 23-1229-FAC1 <br />POLICY NO. 92- A-J324-6 <br />REPLACES NO. 9-EW-N768-1 STATE FARM FIRE AND CASUALTY COMPANY <br />PO Box 853925, Richardson TX 75085-$925 <br />NAMED INSURED & MAILING ADDRESS: <br />Prepared <br />4BATRpRELAMPAGOADEL CIELO <br />SOANBTAXANASCA 92703-0158 <br />Thank you for allowing State Farmfto provide your business with Workers' <br />Compensation Insurance, To help you remain com liantwith your state(s) regulations, <br />required posters have been made available to you through www,statefarin.com! It is <br />YOUR RESPONSIBILITY TO POST this information as required by the state(s) in <br />which you conduct business. <br />To download and printyour required postings: <br />1. Go to www.statefarm.com <br />2. Select Explore (on the top left) <br />3. Under Claims, Select'Claims Help' <br />4. Select Business Insurance Claims (in the left navigation) <br />5. Select Workers' Compensation <br />6, Scroll and locate the State(s) you operate in and click on the link <br />The information on the right side of the page includes state required bulletins and posters <br />which need to be printed and dlsabual in your place of business. <br />In addition, while we hope you never experience a workplace injury, we want you to be <br />prepared in the eventyou need to report a claim. You can also download and printthe <br />First Report of Injury documentfrom the same web page. <br />On the right side of the page you will locate the'First Report of Injury; which is <br />YOUR RESPONSIBILITY TO USE TO NOTIFY US OF ALL EMPLOYEE <br />INJURIES as soon as the injury occurs. In addition, the information on the left side of <br />the page is whatyou will need when reporting a claim, including phone and fax numbers <br />and mailing address. <br />If you do not have access to the internet or the ability to printthe required posters, <br />please contact your State Fart agent or call I-B55-264.2229 for a claims kit to be <br />mailed to you. <br />Again, we thank you for choosing State Farm to provide your business with Workers' <br />Compensation Insurance, <br />REVIEWED & APPROVED <br />05 / 20 / 201 9 a9r c3J 2 to 2i-2ntr Iruaoa�I <br />By RISk MANAGEMENT DMSiON <br />©Copyright, State Farm Mutual Automobile Insurance Company, 20e8 � � n <br />Includes copyrighted material of Insurance Services office, Inc., with its permission. 2ZILIALAL <br />RANCINE <br />