CertificatePDF.aspx.pdf

Mike DeWine, Governor Jim Tressel, Lt. Governor Stephanie McCloud, Administrator/CEO

1-800-644-6292 BWC.Ohio.govBureau of Workers' Compensation

30 West Spring Street Columbus, Ohio 43215-2256

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04/18/2025 Date Mailed .Invisible_TemplateName=DP29Delivery_Channel=mailInvisible_Document_Date=2025-04-18Invisible_ClaimNumber=undefinedInvisible_PolicyNumber =80017118Invisible_Recipient=Yahya A HansbhaiInvisible_AddressLine1=7292 CASCADE DRInvisible_AddressLine2=undefinedInvisible_City=WEST CHESTERInvisible_State =OHInvisible_zip =45069-2291Invisible_Country=United StatesInvisible_Document_Context =PolicyInvisible_Watermark_Name =\\mswg9\CoreSystem\PP\ALC\Images\blank.tifInvisible_Creator_Name =BATCH Invisible_Participation_Type =InsuredInvisible_QuoteNumber =undefinedInvisible_FEIN =undefined

Yahya A Hansbhai

7292 CASCADE DR

WEST CHESTER OH 45069-2291

IMPORTANT DOCUMENT: REMOVE AND POST

DP-29 BWC-1629 (Rev. Jan. 10, 2019)

30 W. Spring St.

Columbus, OH 43215

Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law.

Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including installments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292.

This certificate must be conspicuously posted.

Policy number and employer 80017118

Period Specified Below 07/01/2025 to 07/01/2026

Yahya A Hansbhai

7292 CASCADE DR

WEST CHESTER OH 45069-2291

www.bwc.ohio.gov Issued by: BWC

Administrator/CEO You can reproduce this certificate as needed.

Ohio Bureau of Workers' Compensation

Required Posting

Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol, marihuana or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work-related injury.

The burden of proof is on the employee to prove the presence of alcohol, marihuana or a controlled substance was not the proximate cause of the work-related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act.

You must post this language with the Certificate of Ohio Workers' Compensation.

Policy Information

Policy Information for the policy period beginning from 12:01 AM on 07/01/2025 to 12:01 AM on 07/01/2026.

Policy Number and Employer MCO

80017118 Yahya A Hansbhai

7292 CASCADE DR

WEST CHESTER OH 45069-2291

Sedgwick Managed Care Ohio

P.O. BOX 1040

DUBLIN OH 43017

Additional Insured’s Name and Address Effective Date Expiration Date

Individuals Eligible for Elective Coverage Individuals Eligible for Elective Coverage Covered (Yes/No) Elective Coverage Type

Yahya A Hansbhai No Elective - Owner

**Please refer to our website for reporting guidelines/requirements.

Corporate Officer Effective Date Expiration Date No officers listed for this policy.

**Please refer to our website for reporting guidelines/requirements.

Employee Class Codes and Descriptions Class Code Class Code Description

8868 COLLEGE-PROFESSIONAL EMPLOYEES & CLERICAL

The information noted above is as of 04/18/2025. For the most current information on the policy or to update your account information, please log into your account at www.bwc.ohio.gov. You may also call 1-800-644-6292 to speak with a customer service representative.