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Sample Company

112½ Beacon Street
Boston, MA 02108
SIC:0
Class:Bar, Nightclub 899
FEIN:22-123456789
Bureau #:1234567
Expiration:08-30-2020
Renewal Mod:1.23
Carrier
Call
Contacts
Current Term
Class Code Description Base Rate Mod Rate
0 None 0.00 0.00
Carrier History
Policy Term Exp. Mod Carrier LCM
08-30-2020 1.23 Applied Underwriters 1.34
08-30-2019 1.33 Applied Underwriters 1.24

Notes
Agent Date Note
Norm 09-30-1982 First contacted them.
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