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bi '1b ! YE7hb U I ! e' 2bb /113b UHILWJVS .E Ktbl-UH.Lb YNUt Dl <br /> 22 (Policy ProvisionsWC OC 0 ) 00 A <br /> 84 <br /> DC INFORMATION PAGE <br /> ta>c WORKERS COMPENSATION AND EMPLOYERS LIABILITY <br /> POLICY <br /> INSURER : HARTFORD UNDERWRITERS INSURANCE COMPANY <br /> HARTFORD PLAZA , HARTFORD , CONNECTICUT 06 .115 T <br /> NCCI Company Number: SQ4516 1 HE <br /> Company Code : 6 HAx T Fox b <br /> T <br /> O <br /> rS <br /> Suffix <br /> 'i LARS RENtwAt <br /> o POLICY NUMBER : 21 WEC D08422 <br /> ry <br /> Previous Policy Number. � 1 WEC DG8422 <br /> 1 HOUSING CODE : SA <br /> Named Insured and Mailing Address : CHILD CARE: RESOUkCEL' OF INDIAN <br /> H (No . , Street, Town , State , Zip Code) RIVER INC . <br /> 0 <br /> 0 <br /> 18D1 24TH STREET <br /> FEIN Number 6 ; 0523165 VERO BPACH , FL 3:: 963 <br /> Mill State Identification Number(s): <br /> s <br /> The Named Insured is : CORPORATION <br /> Business of Named Insured : CHILD CARE ORGANIZATION <br /> oft Other workplaces riot shown above : 1 BOI 24TH STREET <br /> VERO BEACH FL 32960 <br /> 2 . Policy Period : From 10 / 14 / 06 To 10 / 14 / 0 , <br /> on <br /> 1207 a. m . , Standard time at the Insured's (nailing -address. <br /> mid <br /> me Producer's Name : H " LB ROGAL 6 HOBBB FL -IrTRO BEACH <br /> LRC <br /> u <br /> �C <br /> F'0 BOX 130 <br /> t� VSRO BEACH , FL 32961 <br /> Producer's Code: ' 2 % 809 <br /> Issuing Office: �'H8 hAFcTF'OR7 <br /> 8 ' 1 UNIVERSITY EAST DRI` E <br /> ii-mm— <br /> low CRAfi LOTTE NC 2821 ? <br /> N __ ( +307 ) 853=2582____ _ <br /> Total Estimated Annual Prornium : $ 1 , 080 <br /> Deposit Premium : <br /> Policy Minimum Premium : $ 294 FL ( INCLUDES INCREIwSRD LIMIT MIN . PREM , } <br /> -- <br /> Audit Period: ANNUAL Installment Term : <br /> The policy is riot binding unless countersigned by oui authorized representative , <br /> alp <br /> Coumersigned by <br /> Authorized Representative Dale <br /> Form WC 00 00 01 A ( 1 ) Purred ii , ., S .A Page 1 (Continued on next page) <br /> Process Date : 08 / 19 / 06 PClicy Fxph anon Date: 10 / 14 i C7 <br /> OR -GINAL <br />