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<br />ii <br />? <br />AH10 Bu?eau of ??or?ersCo13?pe8`9satQon30 W. Sprino << <br />Columbus, OH 432'i?; <br />(Martfficate of Premgt??? ??ym, ant <br />i his csi-tiiies the employer iisted below has paid into the Ohio State insurance Fur+d as <br />requireei. by lavv. Therefore, the employer is enfiii9ed to ihe rights aiid benefifis of the <br />fund for the period speeified. For more inforrnation, call 1-800-OHIOBWC. <br />This certificate must be conspicuously posted. <br />Noli'cy klo. and Employer Period Specified Below <br />1628431 0;/01/2013 fixRU 02/28/2014 <br />A AND NC <br />GREG MI L?i,'ER ?T?I?L OL SERVI CE T NC <br />7368 OaKI-?L ,?20?L? <br />OAKWOOD V??LA0£ OH 5- 5 904 <br />onioDwc.com ?drninistr'atoNCEO <br />:t,. -........_._ <br />You can reproduce this ceriificate as needed. <br />? <br />(01-.?!a Bureau of P??irke[rs° Coc????se-eflan <br />Requir8d, Pc??thlo, <br />Effective Oct. 13, 2004, Section 4123.54 ff, the Ohio Revised Code <br />requires notice of rebuttable presuri-iption. Rebuttable presump-tian <br />means ara employee may dispute or prove un-"srue the presurrption <br />(or belief) fihat alcohoi or a controlied saabstGr€ce noi prescribed <br />byihe employee's physician is fihe proxirraate cause (rnain reason) <br />of the wor!<-related injury. <br />The burden of proaf is on the employee ta prove ihe presEncs ot <br />alcohol or a contralied substance was nat 'Lhe pro ;imate cause or <br />the worCc-related ii-ijuryo An emplovee who fiests positive or refuses <br />fo submit to chemicai testing may be disqualifiied for compensation <br />and benefits under the !/Verkers' Compensation Act. <br />? <br />Bureau of Wor?cers° <br />?-Al A"A.- V I coinpensat8on - You mus[ post tnis langu2ge with the certificate of premium paymeni. <br />n. . ? . ...,_ ;1, <br />BVVC-16?.Q 7r7inR