Michigan Workers Compensation Placement Facility Depopulation Report Page 1 Assigned Risk Renewals: October/November/December Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge EMERSON GEOPHYSICAL LLC ACME 5066565A 2,755 12/20/2021 8601 1.00 BA VENTURES LLC ADA 6072330A 2,689 11/8/2021 9402 FUNNY BUSINESS AGENCY INC ADA 2464470A 830 10/25/2021 8742 0.95 JUNGLE SURVIVAL DRIVERS TRAINING LLC ADA 5003229A 1,228 10/28/2021 8868 0.95 MAKUSKI BUILDERS INC ADA 3236854A 750 10/25/2021 5645 RAM CREATIVE LLC ADA 5732875A 353 10/15/2021 8601 RED MAPLE ROOFING INC ADA 6284590A 800 12/19/2021 5551 ROLLING GREY ADA 5774233A 313 11/3/2021 8601 ROOF SEAL LLC ADA 6051880A 750 10/5/2021 5551 VAN DYKE MATTHEW ADA 5928729A 307 10/27/2021 0908 FIX ER UP CONSTRUCTION LLC ADRAIN 5638127A 3,951 10/10/2021 5645 CLEAR VIEW WINDOWS INC ADRIAN 3383822A 763 11/27/2021 8742 LENAWEE DEVELOPMENT CORP ADRIAN 3631710A 2,277 11/11/2021 9052 0.95 MAPLE CITY GYMNASTICS CENTER LLC ADRIAN 2020262A 1,011 12/29/2021 9063 METCAN USA CORPORATION ADRIAN 5280877A 7,821 12/31/2021 1748 0.91 PHENICIES ENTERPRISES LLC ADRIAN 6255582A 1,187 10/7/2021 5221 RUTTKOFSKY BUILDERS INC ADRIAN 3456218A 750 11/18/2021 5645 SHARE THE WARMTH ADRIAN 5930995A 737 11/2/2021 9052 WALLICH CONSTRUCTION COMPANY ADRIAN 2272822A 4,809 11/30/2021 5437 0.95 SHAUN HOPE ENTERPRISES LLC AFTON 4821491A 1,500 12/14/2021 0042 0.95 WILSONS DRYWALL AFTON 2840294A 750 11/3/2021 5445 0.95 DASHBOARD CONTRACTORS ALANSON 5929717A 833 11/2/2021 9015 ZEKELMAN ALAN ALBANY, NY 5941423A 637 12/1/2021 0908 LONG HAUL PRODUCTIONS INC ALBERTVILLE, MN 5632269A 446 12/14/2021 7610 STOWELL N SONS ALBION 6077897A 800 11/21/2021 5551 ARNOLD SCOT ALEXANDRA, VA 6276385A 1,026 11/20/2021 9015 CAPTAIN SALS MARINE SERVICE LLC ALGONAC 6253652A 515 10/1/2021 8387 CHAMPIONS AUTO FERRY INC ALGONAC 0318116A 2,680 12/31/2021 6826 0.95 DISCOUNT PEST CONTROL LLC ALGONAC 5984114A 613 10/8/2021 9015 WEATHER PROOF WINDOW & DOOR CO INC ALGONAC 0216186A 800 11/3/2021 5645 AGRI EQUIPMENT SERVICE INC ALLEGAN 2490536A 11,507 12/7/2021 3724 0.84 IDEMA RICK ALLEGAN 6265278A 750 10/28/2021 5645 KUGELARD CONSTRUCTION LLC ALLEGAN 5670489A 338 12/5/2021 5606 1.29 13 % LOMAXX ROOF REPAIR LLC ALLEGAN 5941369A 750 12/1/2021 5551 STRABBING STORM RESTORATION LLC ALLEGAN 6001718A 750 11/5/2021 5437 6/30/2021 9:11:11 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 2 Assigned Risk Renewals: October/November/December Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge ASTALOS LUXURY FLOOR COATINGS LLC ALLEN PARK 6138411A 906 10/3/2021 5221 BOLT REPAIR COMPANY ALLEN PARK 5198631A 1,838 10/24/2021 7208 0.95 LAURA A KOZLOWSKI INSURANCE AGENCY INC ALLEN PARK 4857437A 346 10/18/2021 8810 LIBERATI AND SONS CONSTRUCTION INC ALLEN PARK 3708705A 825 10/29/2021 5022 PRO UNDER PRESSURE CLEANING LLC ALLEN PARK 5743257A 643 11/13/2021 9015 PROGRESSIVE REAL ESTATE LLC ALLEN PARK 5788331A 917 11/28/2021 5606 SEAL WELD LLC ALLEN PARK 5795958A 2,392 12/12/2021 3365 0.95 TODD FELT INC ALLEN PARK 2269465A 2,099 12/29/2021 5445 1.00 TOTALLY AFFORDABLE SEAMLESS GUTTERS INC ALLEN PARK 2859637A 781 12/13/2021 5538 BAUGHER JONATHON M ALLENDALE 5901898A 750 10/3/2021 5645 BERENS DRYWALL INC ALLENDALE 2070162A 750 11/5/2021 5445 CAIN JACOB ALLENDALE 5902053A 750 12/13/2021 5645 ELYSIAN BUILDERS LLC ALLENDALE 5607086A 1,025 11/28/2021 5645 GUARANTEED APPLIANCE REPAIRS ALLENDALE 4221230A 769 10/22/2021 9519 HOMEWORK SERVICES INC ALLENDALE 4276779A 470 10/17/2021 5190 J AND J INSULATING LLC ALLENDALE 5937760A 2,946 11/29/2021 5479 0.95 LAKE EFFECT SNOWPLOWING LLC ALLENDALE 4706560A 739 12/2/2021 9402 0.95 MACS HEATING & COOLING INC ALLENDALE 4276175A 674 10/17/2021 5550 MIKE KUIPERS DRYWALL LLC ALLENDALE 2740737A 750 10/8/2021 5445 MORREN MOLD & MACHINE INC ALLENDALE 5753147A 788 10/12/2021 4484 TIMBER CREEK LLC ALLENDALE 5578515A 750 12/3/2021 5645 0.95 VRUGGINK GORDON ALLENDALE 6054200A 739 12/4/2021 6217 JAMES DZIESZKOWSKI LLC ALLENTON 2589508A 481 11/22/2021 8395 OASIS IRRIGATION & LIGHTING SYSTEMS INC ALLENTON 3051595A 1,234 11/7/2021 5190 JOHN CLARK TRUCKING LLC ALMA 6275281A 750 11/18/2021 7208 LOTT BUILDERS LLC ALMA 3851354A 2,662 11/6/2021 5645 0.95 SAFETY FIRST SECURITY SERVICES LLC ALMA 4150449A 499 11/13/2021 7720 SEVEN STAR PARTY STORE ALMA 6067212A 795 10/29/2021 8017 BC ROOFING & REMODELING LLC ALMONT 5942063A 750 12/4/2021 5437 TRI COUNTY PLUMBING & MECHANICAL INC ALMONT 6072208A 636 11/7/2021 5183 APR STEEL INC ALPENA 2026058A 9,798 10/9/2021 5538 1.38 13 % B AND J YOUNG INC ALPENA 3177769A 842 11/30/2021 8017 0.95 FITZS CARPET SERVICE ALPENA 6275265A 590 11/18/2021 9521 MEM NORTHERN PROPERTIES & RENOVATIONS ALPENA 6264433A 961 12/8/2021 5437 LLC 6/30/2021 9:11:11 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 3 Assigned Risk Renewals: October/November/December Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge SPEEDY BLAZE PRODUCTS LLC ALPENA 6251633A 2,439 10/8/2021 2841 TONYS TREE & YARD SERVICE ALPENA 5072719A 750 10/6/2021 0106 BLUE SKY LOGISTICS INC ALTO 5947936A 750 12/28/2021 7208 EDGAR HOME IMPROVEMENT LLC ALTO 6254462A 750 10/9/2021 5645 ZOOK FARM EQUIPMENT INC ALTO 2807173A 61,979 12/31/2021 5538 1.16 SOUTHERN MICHIGAN GYMNASTICS & FITNESS ANGOLA, IN 2492121A 353 11/17/2021 9063 CENTER LLC ADAMS TREE SERVICE LLC ANN ARBOR 3063801A 751 12/4/2021 0042 0.95 ADVANCED ENVIRO CLEAN LLC ANN ARBOR 6273718A 2,707 11/12/2021 9015 ALBIN OWEN ANN ARBOR 6253636A 307 10/1/2021 0908 ANN ARBOR ASPHALT AND CONCRETE PAVING ANN ARBOR 5177839A 2,080 11/15/2021 5221 1.00 LLC AUBREES FLAGSTAR LLC ANN ARBOR 5346886A 464 11/22/2021 8810 BISHARA SARAH ANN ARBOR 5947111A 910 12/18/2021 0913 CLARKCONSULTS LLC ANN ARBOR 5338182A 313 11/1/2021 8601 COMMUNITY MENTAL HEALTH PARTNERSHIP OF ANN ARBOR 5339189A 2,277 11/4/2021 8810 0.95 SOUTHEAST MICHIGAN CONTINENTAL WHOLESALE INC ANN ARBOR 5828155A 753 10/30/2021 8810 EXECUTIVE PAINTING SERVICES LLC ANN ARBOR 4497309A 1,849 10/24/2021 5476 FULL LIFE INDEPENDENCE LLC ANN ARBOR 5930162A 2,849 11/1/2021 8835 0.95 GILAD MARCIA ANN ARBOR 6266479A 307 11/2/2021 0908 GILAD YOAV ANN ARBOR 6266487A 307 11/2/2021 0908 I DRINK PRODUCTS INC ANN ARBOR 5330203A 569 10/20/2021 8018 INNOVATIVE SOLUTIONS TECHNOLOGIES ANN ARBOR 4641299A 2,671 12/21/2021 4558 0.95 JDP MANAGEMENT LLC ANN ARBOR 3416232A 666 11/3/2021 9015 JOYWORKS LLC ANN ARBOR 5213770A 601 10/7/2021 3081 KARIN AND COMPANY SALON LLC ANN ARBOR 6274323A 959 11/14/2021 9586 KB LANDSCAPE LLC ANN ARBOR 6284604A 2,544 12/21/2021 0042 KRULL ENTERPRISES LLC ANN ARBOR 6088147A 5,466 12/27/2021 9015 KRZYZANIAK EXCAVATING INC ANN ARBOR 1165364A 789 11/15/2021 6217 LABH ENTERPRISE INC ANN ARBOR 3415074A 1,462 12/3/2021 8017 1.00 M AND P CONSTRUCTION INC ANN ARBOR 3333396A 898 11/1/2021 8810 MAPLE VILLAGE SALINE CONDOMINIUM ANN ARBOR 5200741A 1,424 10/18/2021 9015 0.95 ASSOCIATION MENOMINEE OPERA HOUSE COMMITTEE INC ANN ARBOR 5340624A 349 11/6/2021 9154 MICHIGAN LEARNING COMMUNITY LLC ANN ARBOR 6274170A 793 11/14/2021 8835 6/30/2021 9:11:11 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 4 Assigned Risk Renewals: October/November/December Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge MICHIGAN MUTUAL AID BOX ALARM SYSTEM ANN ARBOR 5335302A 6,937 11/20/2021 7704 0.93 ASSOCIATION MOBILE AUTO TRIM INC ANN ARBOR 2207230A 496 12/5/2021 8810 MTRI INC ANN ARBOR 6074812A 864 12/3/2021 4361 MUSKOVITZ MELVIN ANN ARBOR 2180987A 307 11/2/2021 0908 OUR HOUSE ANN ARBOR 5913900A 502 11/29/2021 8832 PALMER AND JOY PROPERTY PRESERVATION ANN ARBOR 6273645A 618 11/19/2021 9015 LLC PAULS PLUMBING SERVICES LLC ANN ARBOR 6285651A 983 12/24/2021 5183 PAYZANT FREDERICK ANN ARBOR 2606550A 750 11/14/2021 5221 PHOTOCAD LLC ANN ARBOR 5269245A 797 11/9/2021 8017 RYAN CHRISTOPHER ANN ARBOR 5343771A 530 12/29/2021 0913 SERGE VAN DER VOO LANDSCAPES LLC ANN ARBOR 5481325A 288 11/19/2021 8601 SNOW X INC ANN ARBOR 0277983A 4,122 11/18/2021 9402 0.93 SPECTRUM THERAPY CENTER INC ANN ARBOR 5186668A 4,373 11/20/2021 8832 0.95 STATE THEATER CONDOMINIUM ASSOCIATION ANN ARBOR 6284566A 643 12/22/2021 9015 STATEWIDE TOWING AND RECOVERY MICHIGAN ANN ARBOR 5943019A 750 12/8/2021 7208 LLC TONYS ROOF REPAIR LLC ANN ARBOR 2906287A 750 10/24/2021 5645 VANFOSSEN MARCIA ANN ARBOR 6052789A 307 10/8/2021 0908 WALNUT RIDGE CONDOMINIUM ASSOCIATION INC ANN ARBOR 3964027A 568 10/21/2021 9015 WASHTENAW CONTRACTORS ASSN ANN ARBOR 0703834A 215 12/12/2021 8810 WORKFORCE CONTINGENT STAFFING INC ANN ARBOR 5142512A 454 10/24/2021 3629 SVARE ENGINEERING GROUP LLC ANOKA, MN 5079047A 2,289 11/18/2021 8720 0.95 ARCADIA TOWNSHIP OF MANISTEE COUNTY ARCADIA 0288950A 2,407 11/27/2021 7704 0.95 CERTIFIED PLUS STAFFING ARMADA 4510747A 768 12/23/2021 8810 1.33 13 % CORNERSTONE FLOORS LLC ARMADA 3456315A 750 12/4/2021 5437 GONZALEZ JOSE ARMADA 5723345A 598 11/7/2021 9102 LUANS WELDING AND STEEL COATING LLC ARMADA 4988035A 2,937 10/3/2021 3365 0.95 NORTHERN LIGHTS DECORATING LLC ARMADA 5630533A 470 11/1/2021 5190 USHER LOGGING LLC ARNOLD 2330652A 750 10/9/2021 7208 0.95 JL MEYERS TRUCKING LLC ASHLEY 6275206A 750 11/18/2021 7208 ZAMARRON JEREMY ASHLEY 4719336A 750 11/16/2021 2702 SUSANS ROADSIDE DINER ATLANTA 5580625A 653 12/19/2021 9058 TRI TOWNSHIP FIRE DEPARTMENT ATLANTA 2465540A 1,062 11/3/2021 7704 0.95 COPONEN DUANE ATLANTIC MINE 3960064A 750 12/7/2021 5645 6/30/2021 9:11:11 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 5 Assigned Risk Renewals: October/November/December Employer Name City RISK ID# Est.