Lead Type: Workers Compensation
Date Received: 01/07/2006

Contact Information:
Business Name: R&R Stone Work
Contact Name: Patricia Roxell
Address: 583 Avant Road Yulee, FL 32097
Phone Number: 904-225-1038
Fax: 904-225-1088
Email: rox447@adelphia.net

Business Information:
Legal Entity: Corporation
Industry: Masonry Contractors
Nature of business: stone and brink on residential new construction
Number of owners: 4
Number of FT emp: 5
Number of PT emp: 0
Number of subs: 0
Employees outside state: No
States:
Employee Job Description:
Year started: 2003
Years of Experience of Owner: 40

Currently insured for WC?: Yes
If yes, Carrier: Wausa
Expiration date: 03/01/2006

Workers Comp Features:
Number of Employees Covered: 9
Claims the last 3 years: None
Premium Range: Not Insured
Liability Coverage: Less than $1,000,000
NCCI Rating:
Date to go in Effect: 2 Months

Other info your Agent needs to know: