250 West Main Street, Suite 900 Lexington, KY 40507-1724 859-425-7800 www.kemi.com
00913 Kentucky State University Attn Candice Raglin Director of HR 400 E Main St ASB-429A Frankfort, KY 40601
Kentucky State University Attn Candice Raglin Director of HR 400 E Main St ASB-429A Frankfort, KY 40601
Kentucky Employers Mutual Insurance 250 W Main Street, Suite 900 Lexington, KY 40507 www.kemi.com 859-425-7800 / 800-640-5364
Quote Date: June 6, 2022
Legal Entity: Other FEIN: 611099712
Prospective Insured:
Name: Kentucky State University
Address: Attn Candice Raglin Director of HR 400 E Main St ASB-429A
City: Frankfort, KY 40601
Agency: AssuredPartners NL Insurance LLC
Agent Number: 633
Address: 2305 River Rd
City: Louisville, KY 40206
Phone: (502)894-2100
Renewal Quote for Workers Compensation Coverage 398982-07/01/2022-07/01/2023
Proposed Effective Date: 07/01/2022 Proposed Expiration Date: 07/01/2023
Employer’s Liability Limits: (3.B) Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease
PLAY 398962 RECIPI: In B068 32000 CHES: m AGNT 103985 Page 1 of 40
Proposed Expiration Date: 07/01/2023
Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease
$1,000,000 each accident
$1,000,000 policy limit
$1,000,000 each employee
June 6, 2022
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