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Digital Provenance
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Publisher
University of Nevada, Las Vegas. Libraries
Transcription
PACIFIC EMPLOYERS INSURANCE COMPANY Home Office: LOS ANGELES, CALIFORNIA Location___ 1033 S o u t h . H o p s S t . __________ ? 1 J E H S E N ______________________________________________ Address- 2Q5 BRXDGUB C Th L E T , LA. HEVALk Agency- Broker— H» Q» -Policy N o____ UP—1 9 ~i 8 -From------------- ^ - l y - A 6 -To______ A-1 9 -1 6 ? •?'TT & Ctl AMPLER -Policy D ate --""IS"*4 6 / 4 7 C O D E NO. 3 4 7 0 D E S C R IP TIO N OP W O R K JOB #2 aiehigaa truest crane with backet for use in construction of new reservoir. EXCAVATION PAY R O L L 42.02 B O D IL Y IN J U R Y 1 . 6 1 1 68 P R O P E R TY DAMAGE R A T E 1.66 P R E M . 7 0 Total Earned Premium_____ Advance or Deposit Premium. Additional Premium_______ Return Premium__________ __________ N e t P r e m iu m _________________________________________________ Additional ____ 11/14/47__________ A. liARLlH G-63J-A 50M 10-47 _______ 7 0 Return. Auditor
