Michigan Workers Compensation Placement Facility Depopulation Report Page 1 Assigned Risk Renewals: April/May/June Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge DANIEL EIZANS STRATEGIC SERVICES LLC ADA 5561051A 423 5/13/2019 8810 EARLY MENTORING PARTNERS ADA 5394830A 334 4/14/2019 8601 JOHNSON HOMES INC ADA 4417810A 750 5/25/2019 5645 MERIDIAN CABLING SOLUTIONS LLC ADA 5862809A 529 5/8/2019 5190 METRIC STRUCTURES LLC ADA 5864330A 1,184 5/14/2019 5606 SUMMIT POINT ROOFING LLC ADA 5412226A 20,801 6/10/2019 5551 0.95 TIP TOP GRAVEL CO ADA 0824453A 9,382 5/10/2019 4000 1.42 13 % TRI ACOUSTIC CORPORATION ADA 0070602A 750 4/13/2019 5445 VAN VOLKINBURG BONNIE ADA 5853745A 283 4/12/2019 8742 WMC SALES LLC ADA 4499743A 1,224 5/6/2019 3724 0.95 WYNN PAINTING ADA 4867777A 800 5/17/2019 5476 SPRINGBROOK CONSTRUCTION LLC ADDISON 3413713A 530 6/2/2019 5190 TOMMYS TEMP SERVICES LLC ADDISON 5722438A 832 6/8/2019 8017 ADRIAN FUELS LLC ADRIAN 4977289A 584 4/19/2019 8017 AKERS DAVID ADRIAN 0991112A 1,310 4/26/2019 5476 AM CONCESSIONS LLC ADRIAN 5723779A 424 6/13/2019 9058 BROWN AND SONS ROOFING AND SIDING LLC ADRIAN 5715180A 768 5/11/2019 5645 CTS SEARCH GROUP INC ADRIAN 5648190A 275 6/7/2019 8810 DOWN UNDER TRENCHING LLC ADRIAN 2692562A 10,567 6/10/2019 7600 1.37 13 % ELITE GROUP INTERNATIONAL INC ADRIAN 4435206A 1,167 4/4/2019 8387 0.95 FASCO EMPLOYMENT INC ADRIAN 0943622A 37,362 5/18/2019 4558 2.04 20 % GERRYS OUTDOOR SERVICES LLC ADRIAN 4971647A 2,408 4/23/2019 0106 0.95 HOWELL HOLDINGS LLC ADRIAN 5735050A 3,768 6/1/2019 7720 IMAGINEERING AND MORE LLC ADRIAN 5720087A 329 6/12/2019 8810 L K N TRUCKING LLC ADRIAN 5591767A 750 4/19/2019 7208 RUTTKOFSKY BUILDERS INC ADRIAN 3456218A 750 5/18/2019 5645 TWO HUNDRED 56 ROBOTICS LLC ADRIAN 5857619A 331 4/21/2019 5191 MAPLE HILL ADULT FOSTER CARE AFTON 5530318A 545 5/10/2019 9053 MIDWAY SPRING INC AFTON 3650634A 543 6/24/2019 8395 CAMP QUALITY USA INCORPORATED AKRON, OH 2642840A 318 4/10/2019 8810 HOUTHOOFD BUILDERS LLC AKRON 2230917A 750 5/13/2019 5437 ALANSON SHEET METAL INC ALANSON 0138630A 742 6/9/2019 5550 0.95 MURPHY SCOTT ALANSON 5016916A 751 6/7/2019 7208 T D LEMIEUR ROOFING LLC ALANSON 5865050A 11,002 5/16/2019 5551 BERLEUE DAVID ALBION 5727227A 749 6/27/2019 7212 1/3/2019 11:00:13 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 2 Assigned Risk Renewals: April/May/June Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge NELSON LARRY ALBION 1005200A 750 6/3/2019 6217 RUSTY 4 FARMS ALBION 0251267A 13,674 5/4/2019 2731 1.44 YOUNGS GAS SERVICE LLC ALBION 0970263A 2,526 6/1/2019 8350 0.95 COMPLETE EXCAVATING SERVICES LLC ALDEN 5863945A 3,737 5/19/2019 6217 GREENWORLD MAINTENANCE LLC ALDEN 2249200A 750 5/4/2019 0042 0.95 NORTHERN SKYLIGHTS LLC ALDEN 4340051A 750 6/27/2019 5550 ABC SERVICES AND FOXFIRE FARM LLC ALGONAC 3792692A 11,761 4/17/2019 9015 1.58 13 % AHEE MASONRY LLC ALGONAC 3612392A 751 6/3/2019 5022 ALT VACANCY SOLUTIONS INC ALGONAC 5383455A 633 4/4/2019 9015 BLUE WATER MATERIALS LLC ALGONAC 3824993A 3,170 6/25/2019 4000 0.95 COLLINS HARDLINE CONSTRUCTION ALGONAC 5877946A 1,340 6/20/2019 7600 POLITO A ALGONAC 3204855A 750 5/16/2019 5645 WHITENACK CONSTRUCTION LLC ALGONAC 5872928A 750 6/5/2019 5437 WINNERS CIRCLE BAR INC ALGONAC 0198986A 523 6/4/2019 9058 YOKOM JAMES ALGONAC 3597610A 750 5/6/2019 5437 ALLEGAN COUNTY AGRICULTURAL SOCIETY ALLEGAN 1602829A 9,542 5/1/2019 9015 1.24 ARM SERVICES INC ALLEGAN 5402360A 634 5/8/2019 9015 BIG REDS WRECKER LLC ALLEGAN 5694000A 6,938 4/6/2019 7208 MARK P JANKE CONSULTING FORESTER LLC ALLEGAN 5256852A 755 4/3/2019 8601 S AND T SEAMLESS GUTTERS AND COVERS ALLEGAN 5848245A 750 4/2/2019 5538 SKY TRAIL MANAGEMENT AND DEVELOPMENT ALLEGAN 4469941A 935 5/4/2019 8810 LLC STARS AND STRIPES ROOFING LLC ALLEGAN 5878454A 800 6/22/2019 5551 TJM SERVICES ALLEGAN 5007046A 750 5/12/2019 8810 BATT CHARLES B ALLEN 3522709A 750 5/31/2019 0106 BIG V LANDSCAPING ALLEN PARK 1829262A 801 6/30/2019 0042 0.95 COSTA ALLEN PARK INC ALLEN PARK 2625075B 823 4/9/2019 9058 0.95 FOURNIER HAL ALLEN PARK 5257239A 750 4/3/2019 5476 GRAND RIVER BARBER COMPANY LLC ALLEN PARK 5876010A 455 6/9/2019 9586 GUTIERREZ CARPENTRY LTD INC ALLEN PARK 5555159A 750 4/27/2019 5645 HAMMERTIME LLC ALLEN PARK 5395747A 750 5/26/2019 5437 LIVIDINI LANDSCAPING LLC ALLEN PARK 5142440A 750 4/3/2019 0042 0.95 MI LAKES TILE COMPANY ALLEN PARK 5853974A 750 4/12/2019 5348 MITTEN CONTRACTING LLC ALLEN PARK 4875214A 7,834 4/5/2019 5645 0.92 STAY AT HOME CARE LLC ALLEN PARK 4883896A 18,849 4/12/2019 8835 1.53 13 % 1/3/2019 11:00:13 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 3 Assigned Risk Renewals: April/May/June Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge T WIN SERVICES ALLEN PARK 0105236A 800 5/19/2019 5476 TUCCINI ORTHODONTIC LABORATORY INC ALLEN PARK 2498880A 473 5/26/2019 4692 DAVE BOSCH BUILDER INC ALLENDALE 4358163A 750 6/13/2019 5645 HARWOOD MACHINE REPAIR & DIAGNOSTIC INC ALLENDALE 5409039A 700 5/30/2019 3724 JMB DEMOLITION LLC ALLENDALE 4445600A 4,452 4/26/2019 7380 0.95 KOOISTRA DURK ALLENDALE 5230047A 750 5/20/2019 7208 MILES ULBERG BUILDERS LLC ALLENDALE 5269725A 1,579 5/25/2019 5437 NORTHSTAR CONSTRUCTION AND RENOVATION ALLENDALE 5409543A 750 6/30/2019 5645 LLC RELIABLE UNDERGROUND SERVICE ALLENDALE 4646690A 1,512 6/7/2019 8601 0.95 TECHNICIANS INC VICTORY CHEERLEADING COMPANY LLC ALLENDALE 3508269A 763 6/5/2019 9063 W S SERVICES ALLENDALE 2877716A 750 6/7/2019 5437 DIVINE FLOOR SERVICES LLC ALLENTON 4882733A 1,876 6/29/2019 5437 0.95 M AND A HOME IMPROVEMENTS ALLENTON 5693667A 750 4/24/2019 5551 MESA REMODELING AND CONTRACTING INC ALLENTON 5859913A 750 4/27/2019 5348 LUNA MASONRY INC ALLENTOWN 3180271A 750 4/10/2019 5022 STURDY BUILT STRUCTURES LLC ALLIANCE, OH 5877466A 4,255 6/18/2019 5040 BJORN EXCAVATING LLC ALLOUEZ 5872367A 3,187 6/1/2019 6217 AFFORDABLE DRYWALL ALMA 5266700A 750 5/1/2019 5445 ALL AMERICAN PEST CONTROL LLC ALMA 4988124A 3,142 5/23/2019 9015 0.95 GUIETT PORTAJOHN RENTALS & SERVICE LLC ALMA 5547130A 1,033 4/18/2019 9402 LOTT BUILDERS LLC ALMA 3851354A 2,709 5/19/2019 5645 0.95 NEW HORIZONS REALTY INC ALMA 5877741A 362 6/16/2019 8742 RAMON ANTHONY ALMA 5697948A 530 4/4/2019 5190 RJ LOTT CONTRACTING LLC ALMA 5731542A 5,076 6/1/2019 5437 JT POWER INC ALMONT 4550897A 3,450 5/18/2019 5190 0.95 LESNIAK AND SONS CARPENTRY LLC ALMONT 4276060A 1,186 5/30/2019 5437 MMH SOLUTIONS INC ALMONT 3021351A 750 6/10/2019 5645 0.93 ORLANDOS MASONRY & CONSTRUCTION LLC ALMONT 5341787A 1,966 4/23/2019 5022 0.95 PERFECTIONIST ALUMINUM ALMONT 5862353A 2,595 5/4/2019 5538 A 1 TREE SERVICE LLC ALPENA 5262720A 3,176 4/17/2019 0106 0.95 ALPENA MAINTENANCE SERVICE ALPENA 3193098A 750 5/25/2019 5476 BIGGBEAN LLC ALPENA 5861691A 1,837 5/9/2019 8017 CAMPERS COVE RV PARK & CANOE LIVERY INC ALPENA 4067908A 1,346 4/1/2019 9015 0.95 1/3/2019 11:00:13 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 4 Assigned Risk Renewals: April/May/June Employer Name City RISK ID# Est. Annual Expire Date Class Exp. Mod Pool Premium Code Surcharge ENVIRONMENTAL AND ASBESTOS SERVICES INC ALPENA 4752880A 593 4/20/2019 8601 KENDZIORSKI PHILIP ALPENA 5881579A 750 6/30/2019 5645 MORGAN FOREST PRODUCTS ALPENA 4067436A 750 5/10/2019 2702 NORTHSTAR EXECUTIVE PROTECTION ALPENA 5335434A 665 5/11/2019 7720 SEVEN ELEVEN NO 36916 ALPENA 1993151A 1,523 4/24/2019 8017 0.95 THUNDER BAY ROOF CO ALPENA 5865182A 10,520 5/18/2019 5551 TRAVIS AND SONS TRUCKING LLC ALPENA 3849120A 2,215 6/12/2019 7208 0.88 BEAVER WOOD TREE SERVICE LLC ALTO 4864441A 10,477 6/30/2019 0106 0.91 BOVERHOF BUILDERS INC ALTO 2714221A 761 5/29/2019 8742 CUTLER JUSTIN ALTO 5856779A 750 4/20/2019 0042 DVB INC ALTO 3453987A 750 4/11/2019 5645 GROOT SERVICES LLC ALTO 5880360A 684 6/28/2019 9102 INTEGRITY FLOORING LLC ALTO 5570972A 750 5/24/2019 5437 LEROUX CONSTRUCTION LLC ALTO 5596580A 750 5/9/2019 5645 VERBURG BUILDERS LLC ALTO 5272769A 750 5/23/2019 5645 IPROLE INC ANAHEIM, CA 5110556A 379 5/8/2019 8742 FIRST CLASS CARPENTRY LLC ANCHORVILLE 5719399A 750 5/24/2019 5437 A 2 SUPPLY CHAIN SERVICES LLC ANN ARBOR 5869951A 2,404 6/1/2019 9015 AARON HAMMER LLC ANN ARBOR 5555418A 1,770 5/11/2019 0042 0.95 ALI BABA DARI INC ANN ARBOR 0826383A 1,988 5/6/2019 9058 0.95 ALLEN LEIGH ENTERPRISES LLC ANN ARBOR 4682653A 1,020 5/20/2019 9063 0.95 ANDY KIRSHNER FILMS LLC ANN ARBOR 5856159A 408 4/19/2019 9156 ANN ARBOR HOSPITALITY LLC ANN ARBOR 2716194A 1,233 5/4/2019 9052 0.95 ANN ARBOR SHUTTLE SERVICE INC ANN ARBOR 2492504B 10,078 6/30/2019 7212 ANTHONYS GOURMET PIZZA INC ANN ARBOR 0143049A 1,764 6/8/2019 9058 0.95 B SQUARED PAINTING LLC ANN ARBOR 5547873A 801 4/19/2019 5437 BENDIT RACHEL ANN ARBOR 3925587A 841 5/18/2019 0908 BERGHOF SYSTEMS INC ANN ARBOR 5127270A 274 4/17/2019 8810 BIRD CENTER OF WASHTENAW COUNTY INC ANN ARBOR 4228863A 963 6/8/2019 8831 0.95 BLACK STEVEN L ANN ARBOR 1993828A 750 6/20/2019 0042 CLEAN AIR MANAGEMENT INC ANN ARBOR 0346381A 832 5/2/2019 4511 CLOVERLY VILLAGE OWNERS ASSOCIATION ANN ARBOR 4235240A 633 4/17/2019 9015 CROSSINGS OF ANN ARBOR ASSOCIATION ANN ARBOR 3608611A 633 4/3/2019 9015 D AND D CONTRACTING LLC ANN ARBOR 5327431A 855 6/6/2019 5645 DAVID BORNEMAN LLC ANN ARBOR 3910296A 1,152 4/13/2019 0042 0.95 1/3/2019 11:00:13 AM /CaomReports/QuarterlyAR Depopulation Report Michigan Workers Compensation Placement Facility Depopulation Report Page 5 Assigned Risk Renewals: April/May/June Employer Name City RISK ID# Est.