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HomeMy WebLinkAboutCOI - Precious Stone PR Inc. - Expires 2022-05-21SCPHS015 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 March 25, 2022 PRECIOUS STONE PR INC 1114 VALBUSA DR GILROY CA 95020 Policy Information: Policy Number:76 WEG AL8BM9 Contact Us Visit https://business.thehartford.com 24/7 access to pay bills, view policy documents, get your certificate of insurance and more. Need Help?Start a live chat online or call us at (877) 287-1316.We’re here weekdays from 8:00 AM to 8:00 PM ET INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy.Please review it at your convenience.If you have questions or need to make further changes, Please contact us. Thank you for allowing us to service your business needs. Sincerely, Your Hartford Service Team DocuSign Envelope ID: 15EA82CB-0272-4FFE-A6E5-99582325582E DocuSign Envelope ID: 15EA82CB-0272-4FFE-A6E5-99582325582E THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 99 00 06 A (1)Printed in U.S.A.Page 1 Process Date:03/25/22 Policy Expiration Date:05/21/22 CHANGE IN INFORMATION PAGE INSURER:Twin City Fire Insurance Company NCCI Company Number:14974 Audit Period:ANNUAL Policy Effective Date:05/21/21 Policy Expiration Date:05/21/22 Policy Number:76 WEG AL8BM9 Endorsement Number:2 Effective Date:02/02/22 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:PRECIOUS STONE PR INC 1114 VALBUSA DR GILROY CA 95020 FEIN Number:86-3717858 Producer Name:AUTOMATIC DATA PROCESSING INS AGCY Producer Code:76250871 It is agreed that the policy is amended as follows: This is NOT a bill.However, any changes in your premium will be reflected in your next billing statement.You will receive a separate bill from The Hartford. In consideration of no change in premium, it is agreed that: Policy is amended to delete the following DBA(s): ESMERALDA OWEN Policy is amended to delete the following Endorsement Forms reflecting the changes made to your policy. WC990365 Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy. WC990006A(.1P) DocuSign Envelope ID: 15EA82CB-0272-4FFE-A6E5-99582325582E SCPHS015 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 March 25, 2022 PRECIOUS STONE PR INC 1114 VALBUSA DR GILROY CA 95020 Policy Information: Policy Number:76 WEG AL8BM9 Contact Us Visit https://business.thehartford.com 24/7 access to pay bills, view policy documents, get your certificate of insurance and more. Need Help?Start a live chat online or call us at (877) 287-1316.We’re here weekdays from 8:00 AM to 8:00 PM ET INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy.Please review it at your convenience.If you have questions or need to make further changes, Please contact us. Thank you for allowing us to service your business needs. Sincerely, Your Hartford Service Team DocuSign Envelope ID: 15EA82CB-0272-4FFE-A6E5-99582325582E DocuSign Envelope ID: 15EA82CB-0272-4FFE-A6E5-99582325582E THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 99 00 06 A (1)Printed in U.S.A.Page 1 Process Date:03/25/22 Policy Expiration Date:05/21/22 CHANGE IN INFORMATION PAGE INSURER:Twin City Fire Insurance Company NCCI Company Number:14974 Audit Period:ANNUAL Policy Effective Date:05/21/21 Policy Expiration Date:05/21/22 Policy Number:76 WEG AL8BM9 Endorsement Number:2 Effective Date:02/02/22 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:PRECIOUS STONE PR INC 1114 VALBUSA DR GILROY CA 95020 FEIN Number:86-3717858 Producer Name:AUTOMATIC DATA PROCESSING INS AGCY Producer Code:76250871 It is agreed that the policy is amended as follows: This is NOT a bill.However, any changes in your premium will be reflected in your next billing statement.You will receive a separate bill from The Hartford. In consideration of no change in premium, it is agreed that: Policy is amended to delete the following DBA(s): ESMERALDA OWEN Policy is amended to delete the following Endorsement Forms reflecting the changes made to your policy. WC990365 Policy is amended to revise the following Endorsement Forms reflecting the changes made to your policy. WC990006A(.1P) DocuSign Envelope ID: 15EA82CB-0272-4FFE-A6E5-99582325582E