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Colonial Life & Accident
Insurance Company
1200 Colonial Life Boulevard
Columbia, SC 29210
803.798.7000
ColonialLife.com
Blank fields represent information not provided or inapplicable to the account.
Account Information
Account Name: Miss Molly's Pastries LLC
BCN: E5529268
Associated With Another Account: No
Other Account Details:
Producer #: 775870
Producer Name: Tracy Jo-Beier Sabol
Authorizing Officer Name: Molly Sullivan
Physical Address: 9201 W. Center Street
Milwaukee, WI 53222
Business Phone: (414) 249-5665 Ext.
Billing Contact: Molly Sullivan
Email: molly@missmollyscafe.com / Title: Owner
Third Party Administrator: No
Public Sector: No
Nature Of Business: RESTAURANTS
Company Web Address: www.missmollyscafe.com
Domestic Partner Allowed: Yes
Welcome Call: No
Preexisting relationship between agent and No
business:
Union or Association: No
Flexible Payment Solution: No

Enrollment Information
Group Products: No
Pre-tax Deductions: Yes
Insurance Advisor:
Target Coverage Effective Date: 07/01/2020
Target Premium Effective Date: 07/17/2020
Payroll Input Date:
Target Enrollment Start Date:
Target Enrollment Stop Date:
Employer Paid: No
Number of Benefit Eligible Employees: 10
Preferred Billing Frequency: Monthly
FICA: Yes
Non-FICA: No
Medicare Portion Only: No

Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, for which Colonial Life is the
marketing brand.
AIF-Summary-2