2019/07/01 San Diego Police Equipment Company, Inc. Workers' Compensation and Employers Liability
Workers Compensation and Employers Liability
Insurance Policy Information Page
1. The Insured Name & Mailing Address:
2. Policy Period:
A Stock Insurance Company
Corporate Offices: San Diego , CA
Carrier Code: 00403
Policy Number: WKN 140539-10
SAN DIEGO POLICE EQUIPMENT COMPANY, INC.
8205 - A RONSON ROAD
SAN DIEGO, CA 92111
Renewal of : WKN 140539-9
FEIN: 33-0713803
Type of Entity: Corporation
This policy is effective from 07/01/19 to 07/01/20 12:01 A.M.
3. Coverage:
A. Workers Compensation Insurance: Part One on the policy applies to Workers Compensation Law
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.
The limits of our liability under Part Two are:
Bodily Injury by Accident each accident.
Bodily Injury by Disease policy limit.
Bodily Injury by Disease each employee.
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
NONE
D. Endorsements and schedules included with this policy:
$1,000,000
$1,000,000
$1,000,000
of the state(s) listed here: CALIFORNIA
PEI101, PEI107, PN049902B, PN049906 C, PN049907, PN049907 A, WC000000 C, WC000421 D,
WC000422 B, WC040301 C, WC040303 C, WC040331 A, WC040360 B, WC040421, WC040422, WC990406,
WC990603
Minimum Premium: $750
Billing:Direct
Premium Adjustment Period: MONTHLY
Producer:PREFERRED CONNECT INSURANCE CENTER
P O BOX 85234
SAN DIEGO, CA 92186
(888) 656 - 5678
Issue Date: 06/13/19 at SAN DIEGO , CA
PEI 100
04/01/98
Authorized Representative
Total Estimated Policy Premium:$7,928
Deposit Premium:$793
Deposit premiums do not include any installment fee. An installment fee of $8 will apply to
future installments, if any, and will be indicated on your invoice.
Refer To Signature Page
4. Premium: The premium for this policy will be determined by your manuals of rules, classifications,
rates and relation plans. All information required below is subject to verification and change by audit.
See Classification and Rating Schedule.
Workers Compensation and Employers Liability
Insurance Policy Information Page
Policy Number: WKN 140539-10
Classification and Rating Schedule
Estimated
Class Code Description Payroll Rate Premium
8018 59,376 $4,067STORES WHOLESALE N.O.C.6.85
8742 276,600 $1,964SALESPERSONS OUTSIDE 0.71
8810 451,499 $2,935CLERICAL OFFICE EMPLOYEES N.O.C.0.65
$-1,345SCHEDULE RATING 0.850
$307TERRORISM RISK INSURANCE ACT 0.039
$22CA FRAUD ASSESSMENT 0.0028780
$110CA WCARF ASSESSMENT 0.0144790
$6CA UEBTF ASSESSMENT 0.0008310
$21CA SIBTF ASSESSMENT 0.0027370
$29CA OSHF ASSESSMENT 0.0037650
$26CA LECF ASSESSMENT 0.0034310
$8,142Total Policy Amount
Refer To Signature Page
Authorized Representative
PEI101
04/01/98
Liability Insurance Policy
Workers Compensation and Employers
WC 99 06 03 (01-06)