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Carolina Casualty Insurance Company <br />9301 Innovation Drive <br />Suite 200 <br />Manassas, VA 20110 <br />Workers Compensation and Employers <br />Liability Insurance Policy <br />Policy Number Policy Period <br />From To <br />BNUWC0149018 09/08/2019 09/08/2020 <br />(12:01 AM at the insured location) <br />Information Page <br />Renewal/Rewrite of Policy Number <br />NJTIN: NEW <br />1. Named Insured and Address <br />Agency Information <br />Korson Inc <br />387000 <br />ASAP Towing <br />YouZoom Insurance Services, Inc DBAYouZoom <br />1906 S Olive St <br />Insurance Services <br />South Bend, IN 46613 <br />6900 College Blvd, Suite 1000 <br />Overland Park, KS 66211 <br />Carrier No. FEIN <br />Risk ID Entity Type <br />11746 262149820 <br />131144806 Corporation <br />Additional Workplaces not shown above: <br />Refer to Schedule of Locations Endorsement WC 99 06 02 (01-06) <br />2. The Policy Period is from 09/08/2019 to 09/08/2020 12:01am Standard Time at the insured's mailing address. <br />A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states <br />listed here: IN <br />B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of <br />our liability under part Two are: <br />Bodily Injury by Accident $500,000.00 each accident <br />Bodily Injury by Disease $500,000.00 policy limit <br />Bodily Injury by Disease $500,000.00 each employee <br />C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states and U.S. <br />territories except Alaska, Hawaii, Maine, New York, North Dakota, Ohio, Washington, Wyoming, Puerto Rico, and the <br />U.S. Virgin Islands, and states designated in Item 3.A. of the Information Page. <br />D. This policy includes these endorsements and schedules: SEE ATTACHED SCHEDULE <br />4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All <br />Information required below is subject to verification and change by audit. <br />SEE ATTACHED CLASSIFICATIONS OF OPERATIONS <br />Minimum Premium $1,000.00 Total Estimated Annual Premium $8,521.00 <br />Premium Discount <br />Expense Constant $320.00 <br />Deposit Premium $1,718.00 <br />Premium Payment Plan: Q Direct Bill 0 Agency Bill <br />Premium Adjustment Period: Q Annual 0 Semi Annual 0 Quarterly 0 Monthly <br />Issue Date: 09/06/2019 <br />Issuing Office: BerkleyNet <br />Authorized Representative <br />WC 00 00 01 A (05-88) <br />Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. <br />© 1996 National Council on Compensation Insurance, Inc. <br />