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<br />INFORMATION PAGE <br /> <br />QARJlER CODE ,_ <br />SCF OF ARIZONA <br />3030 N. 3rd st Phoenix, AZ 85012-3039 <br /> <br />DOC TYPE: INFPG <br /> <br />TYPE OF OWNERSHIP: Corporation <br /> <br />POLICY NO: 400892 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />A/-Z.Q:0- 078 <br /> <br />OWNERSHIP NAMES: <br />Owners, if appiicable, are shown on Endorsement 1070 <br /> <br />Item 2. Policy Period FROM: 08101/2006 TO 0610112007 <br />12:01 a.m. AriloollTi"'eallh8ltdn'flS"'llllhein!lUre<:!1I9$1lll&dherein <br /> <br />Item 1. NAME OF INSURED <br /> <br />Item 3. A. WOOIenlCOO1pensation 10$\lrar10&: Part ~ ollhe policy <br />AppliesIQtheWOfkllrs~lawolAllz[JnB <br /> <br />B. Employers Liability Insul"lll'108': Part Two 01 the poIiOJ applIes <br />fQvtClOr;fnAnzonll <br /> <br />NET TRANSCRIPTS INC <br />3295 N DRINKNATER #12 <br />SCOTTSDALE AZ 85251 <br /> <br />Thelimilsofourliabi~tyunde,f'artTwoare <br />Borlllylnjuryt7fAccidenl $ 100,000 <br />BodllylniurybyOi~_ $ 100,000 <br />Bodily Injuiy by Dise_ $ 500.000 <br /> <br />lIac:hsllx:iden1 <br /> <br />llflChernployee <br /> <br />poliOI' ~mil <br /> <br />C. Olh&r SlalK InSUf8l10&: Pert Three 01 Ih& policy appIill$lo "ri;woa <br />EmpIoye,a per tho lemlS 01 fie OIf1&r Slat" CoveragCl Endorsorlllllll. <br /> <br />SOlI !tom 4. belowr lor olh!lrwol1q:Mcllo; not ~KJWn fll:love <br /> <br />THE COMPANY RESERVES THE RIGHT TO eXCLUDE COVERAGE UNDER PART TWO FOR REJECTORS PREMIUM BASIS <br />Item". Claesil'C8II<Jf1 of Operations The pr<<ni..-n lor h" policy wi. be deleminad I'l' our manueI 01 rules, <br />Premium OlIgg dll!lSiliwon~,nllflSarn:lratlngp- Alinformalionrequirodbelcm EstimaledTotaI <br />Pemld Codes iIllUbjeet 10 veri!iclmon and ~ by audit Amual A6lTJlI'\MlUIon <br /> <br />RATES <br />""'0 <br />PeriB100 <br />olPay,oIf <br /> <br />ESTIMATED <br />ANNUAL <br />PREMIUM <br /> <br />1 <br /> <br />3295 N Drinkwater #12, Scottsdale AZ 85251 <br /> <br />08101/2006 <br /> <br />08101/2007 <br /> <br />08101/2006-08101/2007 8742-G05SAlESlCOllECTORlMESSENGERlO <br />UT <br />8742-OO5SALESlCOllECTORlMESSENGERlO <br />UT <br />881Q-005CLERICAlOFFICE <br />EMPLOYEES-N.O.C. <br /> <br />$32,000 <br /> <br />0.44 <br /> <br />$141 <br /> <br />$90,000 <br /> <br />0.44 <br /> <br />$396 <br /> <br />$178,000 <br /> <br />0.26 <br /> <br />$463 <br /> <br />'THIS IS NOT A BilLING' <br /> <br />9740 <br />9741 <br /> <br />Manual Premium <br />Employe~s liability Limits @ NA <br />Balanoe to Policy Minimum Premium <br />Experienoe Modifier (See Endorsement 1(65) <br />Standard Premium <br />State Fund's Premium Deviation 0.9000 <br />Terr. Risk Ins. Act (See Endorsement 1099) <br />DTEC (See Endorsement 0462) <br />Policy Charge <br /> <br />$1 ,000 <br />NA <br /> <br />$300,000 <br />$3OQ,OOO <br /> <br />0.0300 <br />0.0100 <br /> <br />NA <br />$1,000 <br />$100cR <br />$90 <br />$30 <br />$180.00 <br /> <br />IfindiG.'llod.inlarimlldjuslmenls <br /> <br />tdinirTUl'l Premium <br /> <br />RequifedPepo\iitPrernium <br /> <br />Total E$timaledAmual Pnlmilm <br /> <br />ofprfll11lum~fbempdli' Annual 100% D <br /> <br />$203 <br /> <br />$1,200 <br /> <br />$1,200 <br /> <br />E_ <br /> <br />Endorsement DellCription AIIached <br />l00!> 1032A1~ 1060 1065 1075 1011O 6131061310&114$161462611070 <br /> <br />N'...... <br /> <br />Anniversary Raling Date: f)810112006 <br /> <br />~~. COun...._ 07/2712006 <br /> <br />Gj Ii""""":", <br /> <br />PHESfOENI <br /> <br />X. (J s:::/ . ( <br />~tYkY:!.:;L <br />. .... '.., .~/ . <br /> <br />AUTHORIZEO AEPRESENTATIVE <br /> <br />61-31004/Hll2005 <br />