oski, Larry r000c5821 3 0100 230.20 $230.20 Total Due for above Coverages $1,818.80 51,818.80 'Soo Plan Kay EFTA00316505 aetnas NES, LLC RETROACTIVITY CHARGES/CREDITS No Retroactivity Pg. 4 of 7 Prepared Date: 05/15/19 Invoice Number: Triad Number: Account Number: Bill Package: 1001 Coverage