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30 W. Spring St. <br />Bureau. of Workers' Columbus, OH 43215 <br />Ohio. Compensation <br />Certificate of Ohio Workers' Compensation <br />This.certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. <br />Therefore, the employer is entitled to the rights and benefits of the fund .for the period specified. This certificate <br />�nly_�alid_if_uemium __;�nd_assGSsmentS.ill 1-800-644-U92. <br />installments, are paid by the applicable due date. To <br />verify coverage, visit www.bwc.ohio.gov, or ca <br />This certificate must be conspicuously posted. <br />Policy number and employer <br />31814103 <br />MAYFIELD VILLAGE <br />6622 WILSON MILLS RD <br />MAYFIELD VLG, OH 44143-3407 <br />www.bwc.ohio.gov <br />Issued by: BWC <br />Period Specified Below <br />01 /01 /2020 to 01 /01 /2021 <br />Administrator/CEO <br />You can reproduce this certificate as needed. <br />Ohio Bureau of Workers' Compensation <br />Required Posting <br />Section 4123.54 of the Ohio Revised Code requires notice of <br />rebuttable presumption. Rebuttable presumption means an <br />employee may dispute or prove untrue the presumption (or <br />belief) that alcohol, marihuana or a controlled substance not <br />prescribed by the employee's physician is the proximate cause <br />(main reason) of the work-related injury. <br />The burden of proof is on the employee to prove the presence of <br />alcohol,.marihuana or a controlled substance was not the <br />ogee who <br />proximate cause of the work-related injury. <br />An tests positive or refuses to submit to chemical testing may be <br />disqualified for compensation and benefits under the Workers' <br />Compensation Act. <br />Bureau of Workers' <br />0 1113' Compensation You must post this language with the Certificate of Ohio Workers, Compensation. <br />C 11 <br />DP -29 BWC-1629 (Rev. Jan. 10, 2019) <br />