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Digital Provenance
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Publisher
University of Nevada, Las Vegas. Libraries
Transcription
1 PACIFIC e m p l o y e r s in s u r a n c e c o m p a n y Home Office: LOS A N G L E S , CALIFORNIA Location- s o u t h H o p e a t , _________________ Assured_____VIROIL W. GRAHAM-------------------------------------------------------------- Policy N o------V?-l$97---- t o e s s 1*31 i . M AIN f e T . f M B V E G A S , N EVAD A____________ From------------ 1 Q « 2 9 ^ Agency- Broker- JLaL _To_ 2*,20**4^ FWETf 1 CHftSDLEft JPolicy C O D E N O . 5506 D E S C R IP TIO N O F W O R K JOB I 1 Miscellaneous Road Repairs* Sew Reservoir* La® Vegas* Nevada STREET OR ROAD PAVIHG OR REPAVING PA Y R O L L M .3 6 1.71; B O D I L Y I N J U R Y R A T E 76 P R O P E R TY DAMAGE ?996 U Total Earned Premium-------- Advance or Deposit Premium Additional Premium------------ Return Premium----------------- N et P rem ium 76 Additional 1 , 2 0 R eturn Date------ - G-633-A 50M 10-47 11/17/17 A« MARLIN Auditor
