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2020/01/01 JPW Communications, LLC Workers Compensation ApplicationDATE (MM/DD/YYYY) RETRO PLAN INDEMNITY EXPENSE CONSTANT INCREASED LIMITS N/A N/A N/A N/A N/A FAX COMP PART 12/24/2019 Travelers JPW Communications, LLC 2710 Loker Ave W Suite 300, Carlsbad, CA 92010 jenny@jpwcomm.com 4 8999 824843813 1 2710 Loker Ave W Suite 300, Carlsbad, CA 92010 01/01/2020 01/01/2021 CA 1,000,000 1,000,000 CA 1 8810 Clerical Office Employees Other 553,158.00 0.24 1,328.00 CA 1,328.00 160.00 54.00 111.00 1,328.00 1,653.00 PREMIUM DocuSign Envelope ID: 0CAAB2BC-409F-4C34-B6E3-9C232B4C29D7 NONO PRODUCTS: PRODUCT, PHONE: NAME: 11. ANY SEASONAL EMPLOYEES? PHONE: 13. ANY EMPLOYEES WITH PHYSICAL HANDICAPS? NAME: PHONE: NAME: PREMIUM CRIME COMPANY ANOTHER OR CRIME SUBSTANTIAL] CIVIL PENALTIES. (Not applicable in CO, HI, NE, OH, OK, OR, TN or VT; in DC, LA, ME and VA, insurance benefits may also be denied) CA 1 Jennifer Windle Founder and 100 E 0.00 Public Relations Firm (760) 683-8395 Jennifer Windle jenny@jpwcomm.com (760) 683-8395 Jennifer Windle jenny@jpwcomm.com (760) 683-8395 Jennifer Windle jenny@jpwcomm.com DocuSign Envelope ID: 0CAAB2BC-409F-4C34-B6E3-9C232B4C29D7 1/2/2020