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WORKERS CDMPEt, %IRTNTA fJ'f CgLOYERS L IA1310TY 1'OWCY <br />ppI� TT yy N(J, 92- A d3 #- s qq rr 23-1?pp29yy•aF'AC1 <br />Rh�L CLS Nt7, 9-EW-�76 -1 STApaxF8��92 RERAl�alr SIIAL-TX �50g5N3925 <br />NAMED INSURED ✓t MAItINca ADDRESS; <br />$ <br />NT�I AAA A A92iO3-0158 <br />Thank you for allowing State Farrho provide your business with Workers' <br />Compensation Insurance, To help you romain,dVjdk•with-yourstoto(s)regulations, <br />required posters have been made available to you through www,statotarm.com® It is <br />M this information as required by the stata(s) In <br />which you conduct business. <br />To download and printyaur required postings; <br />i, as to www,stateform,com <br />2, Select Explore (an the top left) <br />3, Under Claims, Solect'ClWms Help' <br />4, Seloct Business Insuranoa Claims (In the left navigation) <br />5. Solent Workers' Compensation <br />6, Scroll and ]costs 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 pb.ptad,;Mt AilloyAfl in your place of business, <br />In additlon, while we hope you never experience a workplace injury, we went you to be <br />prepared in the Went You need to report a claim. You can also download and printthe <br />First Report of Injury document from the some web page. <br />On the right side of the page you will locate th.e'First Report of Injury; which is <br />YQ RE QNSIRILITYTOUSET NOTIFY US OF ALL EWR D C <br />INJURIES as soon as the injury occurs, In addition, the information oaths loft side of <br />the page is whatycu will nood when reporting a claim, including phone and fax numbers <br />and rnalling address, <br />If you do not have access to the Internet or the ability to printthe required posters, <br />please contact your State Farm agent or call 1-055.264-22229for a claims ldtto be <br />(nailed to you, <br />Again,we thank you for choosing State Form to provide your business with Workers' <br />Compensation Insurance, <br />REV!♦1 ED & APPRQVEIa <br />Prepared 05 f 20 / 2019 sa, Yz o-ir so iniws�iWNT [XVIxf()N <br />Capytlghr. atsto rarm Muutof AutanwblIo nnsuronoo t:ompany, 2008 <br />Inalodnssopyrlahtedmatorlaloflnsuranooaorvlaosanloa,Ioa•,wllhIto pormloslon. 4)�T <br />NE n, VILLAREAL <br />