Laserfiche WebLink
_, surance L;orporation wURKERS COMPENSATION EMPLOYERS LIABILITY <br /> 47 INSURANCE POLICY-INFORMATION PAGE <br /> �; FL 34232-0303 Policy Number Policy Period To <br /> From % <br /> ` WCX 0014034 10 / 03 / 2006 10 / 03 / 200 -7 <br /> 12:01 A M 8[antlartl T me et [M1e 0escnbM location <br /> RENEWAL DECLARATION Transaction RenewaHRewrite of policy No . t <br /> W <br /> DIRECT BILL CX 0014034 <br /> � . Named insured and Address <br /> KIDS CONNECTED BY DESIGN INCAgent <br /> 117 ATLANTIC AVENUE BRAISHFIELD FL <br /> FT PIERCE FL 34950 5955 T G LEE BLVD STE 200 <br /> ORLANDO FL 32822 - 4423 <br /> Telephone: 407 - 625 - 9911 0002244 <br /> Carrier A FEIN 77 <br /> 13714 Risk ID ar Entity of Insured <br /> 650948854 091423537 CORPORATION <br /> Additional Locations: See Site Location Schedule <br /> 2 The Policy Period is froml0 / 03 / 2006to10 / 03 /200712 : 01 a . m . Standard Time at the Insured 's mailing address . <br /> 3 . A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states <br /> listed here: FL <br /> B . Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A . <br /> The limits of our liability under Part TWO are : <br /> Bodily Injury by Accident $ 100 , 000 each accident <br /> Bodily Injury by Disease $ 500 , 000 <br /> Bodily Injury by Disease $ 1Policy limit <br /> 00 , 000 each employee <br /> C . Other States Insurance : Part THREE of the policy applies to the states, if any, listed here: <br /> ALL STATES EXCEPT NORTH DAKOTA , OHIO , WASHINGTON , <br /> WEST VIRGINIA , WYOMING , STATES DESIGNATED IN ITEM 3 . A . <br /> D. This policy includes these endorsements and schedules: See attached schedule. <br /> 4. The premium for this policy will be determined by our Manuals of Rules , Classifications, Rates , and Rating Plans . <br /> All information required below is subject to verification and change by audit . <br /> SEE EXTENSION OF INFORMATION PAGE <br /> Minimum Premium $ 275 Total Estimated Annual Premium <br /> $ 11 , 357 <br /> Expense Constant $ 200 <br /> Premium Discount $ - 696 <br /> Deposit Premium $ 11 , 357 <br /> [:1This is a Three Year Fixed Rate Policy <br /> Premium Adjustment Period : ® Annual ; ❑ Semiannual ; ❑ Quarterly ; ❑ Monthly <br /> Countersigned this Day of <br /> Issued Date: 09 / 19 / 2006 Authorized % �- <br /> Issuing Office Sarasota , FL P $�ntativel <br /> oa <br /> SPOO1407H Ed. (09-04) <br /> YCOOD001A 105-881 <br /> INSURED COPY <br /> Page I of 4 <br />