NC Sample Audit-WC-GLm

RLDA S S O C I A T E SI N C O R P O R A T E DUNDERWRITING ALERT FORMABC Insurance CompanyWorker`s Compensation AuditControl No.: 123456Ref. #: Insured: ABC Insured Address: Policy No.: 12-WC-234567-89101-2-AC-34567-8910- Somewhere, VA 24382 Audit Date: 06-Feb-08Policy Period: 10/10/2006 to 10/10/2007 Federal ID #: Audit Period: 10/10/2006 to 10/10/2007 Contact: Audit ContactType of Org: Corporation Title: Auditor: John Doe CLASSIFICATION CHANGES:Code No. Code Wording Code No. Code WordingAdd Code: 5437/91341 Floor sanding Delete Code:5445/92338 Drywall8742 outside salesCHANGE IN ENTITY TO:CORPORATION EFFECTIVE DATE OF CHANGE:PARTNERSHIPSOLE PROPRIETORSHIPADDRESS CHANGE: EFFECTIVE DATE OF CHANGE:New Address: ACTUAL EXPOSURES AS COMPARED TO ESTIMATED EXPOSURES VARY BY MORE THAN 20% (EXPLAIN BELOW).UNINSURED OR UNDER INSURED SUBCONTRACTOR EXPOSURE FOUND AT TIME OF AUDIT. PLEASE REFER TO THEATTACHED SUBCONTRACTOR SCHEDULE.COMMENTS:Per audit contact, Sec/Treas:5022, and 5474 above estimate due to more of those type of work during policy period.91583 lower than estimate due to less work. 97447 and 98305 higher due to more of that type of work during policy period. RLDA S S O C I A T E SI N CO R P O R A T E DABC Insurance CompanyWorker`s Compensation AuditControl No.: 123456Insured: ABC Insured Address: 0 Ref. #: Policy No.: Somewhere, VA 24382 Phone No. 555-555-555512-WC-234567-8910- 12-AC-34567-8910-Policy Period: 10/10 ...