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U/ 26! 1200b 10 : 'iU I1r27b / 11 J7 GN1LU��,1Kt Kt SI AJNOtS YFGt tll <br /> 22 (PmicyProvisions : WC OC 00 00 A <br /> B4 <br /> DQ INFORMATION PAGE <br /> WEC WORKERS COMPENSATION AND EMPLOYERS LIABILITY <br /> POLICY <br /> INSURER : HARTFORD UNDERWRITERS INSURANCE COMPANY <br /> HARTFORD PLAZA , HARTFORD , CONNECTICUT Ob .115 <br /> NCCI Company Number: SC456 Tx � <br /> Company Code: 5 HART FOR D <br /> a� <br /> s <br /> M <br /> 0 <br /> o <br /> Suffix <br /> .-[ IARS Rd9CWAL <br /> POLICY NUMBER : 21 WEC D08422 177 10 <br /> ry <br /> Previous Policy Number: 11 WEC D 8422 <br /> a' HOUSING CODE : SA <br /> 1 . Named insured and Mailing Address : CHILD CARL RESOUR"'ES OF INDIAN <br /> (No , Street, Town , Slate , Zip Code) RIVER INC . <br /> 0 <br /> 0 <br /> 1801 24TH STREET <br /> FEIN NUttlber: b50523165 VERO BEACH , rL 32960 <br /> State Identification Number(s): <br /> r� <br /> e� <br /> � The Named Insured is : CORPORATION <br /> Business of Named Insured : CHILD CARE ORG;LVI ZATION <br /> i� Other workplaces not shown above : 1B01 24TH STREET <br /> VERO BEACH FL 32960 <br /> 2, Policy Period: From 10 / 14 / 06 To 10 / 14 / 07 <br /> am <br /> arm <br /> 12 :01 a. m . , Standard tirne at the insured 's mailing �;ddress. <br /> rrr: <br /> Producer's Name : HILB ROGAL HOBBS FL -OSRO PEACH <br /> �e <br /> FO PDX 130 <br /> i VSRO BEACH , FL 32961 <br /> a_ Producer's Code: ' 21809 <br /> iiiiz <br /> Issuing Office : '11.41 hARTF'ORD <br /> _ 871 :. UNIVERSITY EAST DRIVE <br /> �� Cliflh LOTTE NC 28213 <br /> n� <br /> Total Estimated Annual Premium : <br /> Deposit Premium : <br /> i Policy Minimum Premium. $ 294 FL ( INCLUDES INCRt9kS6:D LIMIT MIN . PREM . } <br /> Audit Period: ANNUAL Installment Term : <br /> The policy is riot binding unless a :untr signed by ow authorized representative <br /> Countersigned by <br /> Authorized Representative Date <br /> Form WC 00 00 Ot A ( 1 ) Pt r. ed in j S . A Page 1 (Continued on next page) <br /> Process Date : 0 6 / 2 9 / 0 6 Policy Ex p6 ation Date : 10 / 14 % O7 <br /> OR " GINAL <br />