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    Waldorf received a payment in December for brokerage services. The document provides details of insurance policies for various religious organizations in multiple states, including policy numbers, effective dates, premium amounts, commissions, and payments. It summarizes transactions for Waldorf for the month and includes a total amount payable of $10,745.95.

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    Waldorf received a payment in December for brokerage services. The document provides details of insurance policies for various religious organizations in multiple states, including policy numbers, effective dates, premium amounts, commissions, and payments. It summarizes transactions for Waldorf for the month and includes a total amount payable of $10,745.95.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    6 views1 page

    New 3

    Uploaded by

    Dib Saha
    Waldorf received a payment in December for brokerage services. The document provides details of insurance policies for various religious organizations in multiple states, including policy numbers, effective dates, premium amounts, commissions, and payments. It summarizes transactions for Waldorf for the month and includes a total amount payable of $10,745.95.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    Broker Name Waldorf

    Month Church
    Mutual Received
    payment December

    Policy Effective Surcharg MN_Surc Total Premium Premium Payment Transfer Commission Commission Commission Service Commission Departm Policy
    Account # Policy Type # Date State e hg Premium Audit Endorsement Received Amount Factor Premium Percentage Charge Payment Book ent Type LOB State Name
    0306071 07 976352 2/28/2017 NY 7460.00 .00 125340.00 .00 .00 31335.00 .00 .940481 29472.79 .0500 -3.00 1473.64 1 9035 07 0 31 SISTERS OF ST FRANCIS NEUMANN COMMUNITIES
    0306823 07 910303 7/1/2016 NM .00 .00 96443.00 .00 .00 -15502.00 .00 1.000000 -15502.00 .0500 .00 -775.10 1 9035 07 0 30 ROMAN CATHOLIC DIOCESE OF LAS CRUCES
    0306823 09 011032 7/1/2017 NM .00 .00 16568.00 .00 1045.00 .00 .00 1.000000 .00 .1500 .00 .00 1 9035 09 0 30 ROMAN CATHOLIC DIOCESE OF LAS CRUCES
    0307122 08 974361 3/18/2017 NY .00 .00 29143.00 .00 .00 3416.16 .00 1.000000 3416.16 .1500 .00 512.42 1 9035 08 0 31 FRANCISCAN SISTERS OF THE ATONEMENT AND/OR
    0307122 09 983448 5/9/2017 NY 240.00 .00 47643.00 .00 .00 .00 .00 .994962 -2.98 .1500 3.00 -.45 1 9035 09 0 31 FRANCISCAN SISTERS OF THE ATONEMENT AND/OR
    0307122 13 974363 3/18/2017 NY .00 .00 70459.00 .00 .00 16371.34 .00 1.000000 16401.34 .1500 -30.00 2460.20 1 9035 13 0 31 FRANCISCAN SISTERS OF THE ATONEMENT AND/OR
    0311288 09 010238 7/1/2017 NY 680.00 .00 83178.00 .00 456.50 .00 .00 .991824 .00 .1500 .00 .00 1 9035 09 0 31 CATHOLIC CHARITIES OF THE DIOCESE
    0331428 09 009325 4/30/2017 TX 20.00 .00 16916.00 .00 30.00 .00 .00 .998817 .00 .1500 .00 .00 1 9035 09 0 42 ALL SAINTS EPISCOPAL SCHOOL OF FORT WORTH
    0500049 07 906146 7/1/2016 TX .00 .00 36261.00 .00 .00 2207.00 .00 1.000000 2207.00 .0500 .00 110.35 1 9035 07 0 42 ROMAN CATHOLIC DIOCESE OF LUBBOCK
    0500057 07 065140 12/31/2017 DE .00 .00 392164.00 .00 .00 .00 .00 1.000000 -3.00 .0500 3.00 -.15 1 9035 07 0 07 DIOCESE OF WILMINGTON (THE)
    0500059 07 072074 1/1/2018 NY 17111.00 .00 159559.00 .00 .00 .00 .00 .892760 .00 .0500 .00 .00 1 9035 07 0 31 MARYKNOLL SISTERS OF ST DOMINIC
    0500076 07 911014 7/1/2016 TX .00 .00 561.00 286.00 .00 .00 .00 1.000000 .00 .0500 .00 .00 1 9035 07 0 42 CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE
    0500134 07 072211 1/1/2018 GA .00 .00 166750.00 .00 .00 .00 .00 1.000000 -3.00 .0500 3.00 -.15 1 9035 07 0 10 DIOCESE OF SAVANNAH
    0500169 09 049319 12/8/2017 NY 220.00 .00 57350.00 .00 .00 14501.00 .00 .996163 14445.35 .1500 .00 2166.80 1 9035 09 0 31 ST ANTHONYS HIGH SCHOOL
    0500194 07 963760 2/1/2017 DE 105.00 .00 77634.00 .00 .00 .00 .00 .998647 11.98 .0500 -12.00 .60 1 9035 07 0 07 OBLATES OF ST FRANCIS DE SALES
    0500194 09 014145 7/1/2017 DE .00 .00 33460.00 .00 .00 .00 .00 1.000000 3.00 .1500 -3.00 .45 1 9035 09 0 07 OBLATES OF ST FRANCIS DE SALES
    0500194 09 014146 7/1/2017 DE .00 .00 149985.00 .00 .00 .00 .00 1.000000 3.00 .1500 -3.00 .45 1 9035 09 0 07 OBLATES OF ST FRANCIS DE SALES
    0500206 09 006384 7/1/2017 NY 310.00 .00 87593.00 .00 .00 8248.00 .00 .996460 8215.81 .1500 3.00 1232.37 1 9035 09 0 31 DOMINICAN COLLEGE
    0500207 09 805391 7/1/2015 MA .00 .00 .00 .00 .00 .00 .00 1.000000 .00 .1500 .00 .00 1 9035 09 0 20 CONGREGATION OF THE PRESENTATION MARY
    0500217 07 006360 7/1/2017 NY 45435.00 .00 377575.00 .00 .00 31387.00 .00 .879666 27607.43 .0500 3.00 1380.37 1 9035 07 0 31 ROMAN CATHOLIC DIOCESE OF ROCHESTER
    0500238 09 002799 7/1/2017 NY 80.00 .00 31992.00 .00 .00 .00 .00 .997499 -2.99 .1500 3.00 -.45 1 9035 09 0 31 FORDHAM PREPARATORY SCHOOL
    0500250 09 020366 9/1/2017 MA .00 .00 61720.00 .00 431.50 14564.00 .00 1.000000 14564.00 .1500 .00 2184.60 1 9035 09 0 20 FABER JESUIT COMMUNITY

    10745.95

    Authorized by

    Approved by

    Payable to: Waldorf Risk Solutions LLC


    Address P O Box 590

    City, State, Zip Huntington, NY 11743


    Stub Comment

    Return Check to: Jaime Koehler

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