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Workers' Compensation History

Contractor License #	550605
Contractor Name	JEFF BLACK

Workers' Compensation History

Insurance Company STATE COMPENSATION INSURANCE FUND Policy # 9202934 Effective Date 01/04/2017 Expiration Date 01/04/2025

Insurance Company MARKEL INSURANCE COMPANY Policy # MWC008898901 Effective Date 01/04/2016 Expiration Date 01/04/2017

Insurance Company STATE COMPENSATION INSURANCE FUND Policy # 229-0009262 Effective Date 05/31/1994 Expiration Date 01/01/2002

Insurance Company STATE COMPENSATION INSURANCE FUND Policy # 1193382 Effective Date 04/26/1994 Cancellation Date 05/31/1994

Insurance Company STATE COMPENSATION INSURANCE FUND Policy # 1193382 Effective Date 09/30/1991 Expiration Date 05/31/1994