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Date Created:
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Keywords:April 6, 1973
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April 6, 1973
H. Tracy Hall, Inc. P. O. Box 7533 University Station Provo, Utah 84602
Your application for Workmen's Compensation and Occupational Disease
Insurance, with your required deposit in the amount of $ 57.42_ is
hereby acknowledged. The deposit is held in trust until the cancellation of your policy.
Policy coverage is effective as of April 4, 1973 12:01 AM subject to checks being collectible in full. Your policy and further explanation will be forwarded as soon as possible.
A payroll report form will be sent to you each January and July, on which you must report the total amount of your payroll up to the date of the form, The payroll should be extended as to your rate on the form, and returned with the premium payment.
The law requires that you maintain adequate payroll records as they are subject to periodic audit to adjust or confirm correctness.
We are happy to extend our services to you. Please call upon this office for any assistance we may render to you regarding Workmen's Compensation or Safety Education.
STATE INSURANCE FUND
Underwriter
CALVIN L. RAMPTON