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YOUR WORKERS＇COMPENSATION
INVOICE
您的工伤赔偿 发票

INSURANCE COMPANY OF THE WEST
PO BOX 509039
SAN DIEGO CA 92150－9039
INSURANCE COMPANY OF THE WEST 邮政信箱509039 加利福尼亚州圣地亚哥 92150-9039

Address Service Requested
请求的地址服务
YOUR INSURANCE AGENCY  您的保险代理机构
Professional Insurance Associates，Inc
专业保险协会
3009 Douglas Blvd Ste 300
地址： 3009 Douglas Blvd Ste 300
Roseville CA 95661  罗斯维尔 CA 95661
000000223 MPN105I2032025016105 01100000000498001
WINGTAT CARGO USA INC
14939 SUMMIT DR  14939 峯峯博士
EASTVALE CA 92880  伊斯特维尔 CA 92880
Make easy and secure payments at myresource．icwgroup．com
在 myresource.icwgroup.com 轻松安全地付款
POLICY \＃：WPL－5070383－02
政策 \#：WPL-5070383-02

ACCOUNT \＃： 5000053924  帐户 \#： 5000053924

DESCRIPTION PERIOD AMOUNT DUE  应付金额
Down Payment  预付定金 03 / 17 / 25 − 03 / 17 / 26 03 / 17 / 25 − 03 / 17 / 26 03//17//25-03//17//2603 / 17 / 25-03 / 17 / 26 12 , 206.00 12 , 206.00 12,206.0012,206.00
Assessments \＆Surcharges－CA
评估 \&附加费-CA		 03 / 17 / 25 − 03 / 17 / 26 03 / 17 / 25 − 03 / 17 / 26 03//17//25-03//17//2603 / 17 / 25-03 / 17 / 26 6 , 125.00 6 , 125.00 6,125.006,125.00
Assessments \＆Surcharges－IL
评估 \&附加费-IL		 03 / 17 / 25 − 03 / 17 / 26 03 / 17 / 25 − 03 / 17 / 26 03//17//25-03//17//2603 / 17 / 25-03 / 17 / 26 1.00
Assessments \＆Surcharges－NJ
估价 \&附加费-NJ		 03 / 17 / 25 − 03 / 17 / 26 03 / 17 / 25 − 03 / 17 / 26 03//17//25-03//17//2603 / 17 / 25-03 / 17 / 26 1.00
Invoice Amount：  发票金额： $ 18 , 333.00 $ 18 , 333.00 $18,333.00\$ 18,333.00
DESCRIPTION PERIOD AMOUNT DUE Down Payment 03//17//25-03//17//26 12,206.00 Assessments \＆Surcharges－CA 03//17//25-03//17//26 6,125.00 Assessments \＆Surcharges－IL 03//17//25-03//17//26 1.00 Assessments \＆Surcharges－NJ 03//17//25-03//17//26 1.00 Invoice Amount： $18,333.00| DESCRIPTION | PERIOD | AMOUNT DUE | | :--- | :--- | ---: | | Down Payment | $03 / 17 / 25-03 / 17 / 26$ | $12,206.00$ | | Assessments \＆Surcharges－CA | $03 / 17 / 25-03 / 17 / 26$ | $6,125.00$ | | Assessments \＆Surcharges－IL | $03 / 17 / 25-03 / 17 / 26$ | 1.00 | | Assessments \＆Surcharges－NJ | $03 / 17 / 25-03 / 17 / 26$ | 1.00 | | | Invoice Amount： | $\$ 18,333.00$ |
INVOICE \＃： 810125074  发票 \#： 810125074
FUTURE PAYMENT SCHEDULE  未来付款时间表
05 / 01 / 25 05 / 01 / 25 05//01//2505 / 01 / 25 12 , 206.76 12 , 206.76 12,206.7612,206.76
05 / 31 / 25 05 / 31 / 25 05//31//2505 / 31 / 25 12 , 206.78 12 , 206.78 12,206.7812,206.78
07 / 01 / 25 07 / 01 / 25 07//01//2507 / 01 / 25 12 , 206.78 12 , 206.78 12,206.7812,206.78
07 / 31 / 25 07 / 31 / 25 07//31//2507 / 31 / 25 12.206 .78
08 / 31 / 25 08 / 31 / 25 08//31//2508 / 31 / 25 12 , 206.78 12 , 206.78 12,206.7812,206.78
10 / 01 / 25 10 / 01 / 25 10//01//2510 / 01 / 25 12 , 206.78 12 , 206.78 12,206.7812,206.78
10 / 31 / 25 10 / 31 / 25 10//31//2510 / 31 / 25 12 , 260.78 12 , 260.78 12,260.7812,260.78
12 / 01 / 25 12 / 01 / 25 12//01//2512 / 01 / 25 12 , 206.78 12 , 206.78 12,206.7812,206.78
12 / 31 / 25 12 / 31 / 25 12//31//2512 / 31 / 25 12 , 206.78 12 , 206.78 12,206.7812,206.78
FUTURE PAYMENT SCHEDULE 05//01//25 12,206.76 05//31//25 12,206.78 07//01//25 12,206.78 07//31//25 12.206 .78 08//31//25 12,206.78 10//01//25 12,206.78 10//31//25 12,260.78 12//01//25 12,206.78 12//31//25 12,206.78| FUTURE PAYMENT SCHEDULE | | | :---: | :---: | | $05 / 01 / 25$ | $12,206.76$ | | $05 / 31 / 25$ | $12,206.78$ | | $07 / 01 / 25$ | $12,206.78$ | | $07 / 31 / 25$ | 12.206 .78 | | $08 / 31 / 25$ | $12,206.78$ | | $10 / 01 / 25$ | $12,206.78$ | | $10 / 31 / 25$ | $12,260.78$ | | $12 / 01 / 25$ | $12,206.78$ | | $12 / 31 / 25$ | $12,206.78$ |

Automatic Payments  自动付款

Take advantage of easy，convenient and secureAutomatic Payments by enrolling at myresource．icwgroup．com．
通过在 myresource.icwgroup.com 注册，利用简单、方便和安全的自动付款。

Terms \＆Conditions  条款 \&条件

Payments will be applied in the following order：Oidest premiums（on current or previous policy ferm），past due fees，current premiums and fees．Alternate payment instructions submitted with your check or invoice will not be honored；please contact us if other arrangements are necessary．Balance forward may span multiple periods．Outstanding credit will be applied to this invoice；if total amount due is a credit，it will be applied to your next invoice．Your policy will be subject to cancellation if the total amount due is not received by the due date．There may be a charge of up to $ 25 $ 25 $25\$ 25 for each transaction rejected due to nonsufficient funds（NSF），closed account，or declined card．Any rejected payment or other non－payment of premium may also result in policy cancellation． Thank You for Choosing ICW Group
付款将按以下顺序进行：最佳保费（当前或以前的保单）、逾期费用、当前保费和费用。与您的支票或发票一起提交的替代付款指示将不予兑现;如果需要其他安排，请联系我们。余额远期可能跨越多个时期。未结余额将应用于此发票;如果到期总金额是贷方，它将应用于您的下一张发票。如果满足以下条件，您的保单将被取消在到期日之前未收到应付总额。由于资金不足 （NSF）、关闭账户或信用卡被拒绝而被拒绝的每笔交易可能会收取最高 $ 25 $ 25 $25\$ 25 费用。任何被拒绝付款或其他未支付保费的行为也可能导致保单取消。感谢您选择 ICW Group
Please include this portion if mailing your payment．
如果邮寄您的付款，请包括此部分。
Account Number：  账号： 5 0 0 0 0 5 3 9 2 4 5 0 0 0 0 5 3 9 2 4 5000053924\mathbf{5 0 0 0 0 5 3 9 2 4}
Policy Number：  保单编号： WPL－5070383－02  接线端子 WPL-5070383-02
Invoice Date：  发票日期： 03 / 20 / 2025 03 / 20 / 2025 03//20//202503 / 20 / 2025
Invoice Due Date：  发票到期日： 04 / 04 / 2025 04 / 04 / 2025 04//04//202504 / 04 / 2025
Invoice Number：  发票编号： 810125074
Invoice Amount：  发票金额： $ 18 , 333.00 $ 18 , 333.00 $18,333.00\$ 18,333.00
Amount Paid：  支付金额：
Account Number： 5000053924 Policy Number： WPL－5070383－02 Invoice Date： 03//20//2025 Invoice Due Date： 04//04//2025 Invoice Number： 810125074 Invoice Amount： $18,333.00 Amount Paid： | Account Number： | $\mathbf{5 0 0 0 0 5 3 9 2 4}$ | | :--- | :--- | | Policy Number： | WPL－5070383－02 | | Invoice Date： | $03 / 20 / 2025$ | | Invoice Due Date： | $04 / 04 / 2025$ | | Invoice Number： | 810125074 | | Invoice Amount： | $\$ 18,333.00$ | | Amount Paid： | |
Mail payment to：  将付款邮寄至：

ICW Group Insurance Companies
PO Box 31001－3421
Pasadena CA 91110－3421
ICW 集团保险公司 邮政信箱 31001-3421 加利福尼亚州帕萨迪纳 91110-3421