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Workers' Compensation History

Contractor License #	858532
Contractor Name	JEFFREY JACOBSEN

Workers' Compensation History

Insurance Company CLEAR SPRING PROPERTY AND CASUALTY COMPANY Policy # CWC01358100 Effective Date 12/06/2022 Expiration Date 12/06/2024

Insurance Company STATE COMPENSATION INSURANCE FUND Policy # 9081116 Effective Date 12/06/2018 Expiration Date 12/06/2022

Insurance Company STATE COMPENSATION INSURANCE FUND Policy # 9081116 Effective Date 12/06/2013 Expiration Date 12/06/2018

Insurance Company EXEMPT Policy # Effective Date 06/03/2013 Expiration Date

Insurance Company EXEMPT Policy # Effective Date 04/24/2005 Expiration Date 06/03/2013