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FW A FLORIDA WORKERS' COMPENSATION <br /> JOINT UNDERWRITING ASSOCIATION, INC. <br /> WORKERS COMPENSATION <br /> AND <br /> EMPLOYERS LIABILITY POLICY <br /> TYPE AR INFORMATION PAGE WC 00 00 01 ( A) <br /> POLICY NUMBER : ( GFR1 3UB - 421 1 B59 - 0 - 05 ) <br /> NEW - 05 <br /> INSURER : FLORIDA W . C . JUA <br /> 16 NCCI CO CODE : 80179 <br /> INSURED : PRODUCER : <br /> PROJECT HOPE INC HILB ROGAL & HOBBS OF VB <br /> 4545 38 AVE 2045 14TH AVE <br /> VERO BEACH FL 32967 PO BOX 130 <br /> VERO BEACH FL 32961 - 0130 <br /> Insured is A CORPORATION <br /> Other work places and identification numbers are shown in the schedule (s) attached . <br /> 2 . The policy period is from 04 - 29 - 05 t0 04 - 29 - 06 12 : 01 A . M . at the insured 's mailing address . <br /> 3 . A . WORKERS COMPENSATION INSURANCE : Part One of the policy applies to the Workers <br /> Compensation Law of the state (s) listed here : <br /> FL <br /> B . EMPLOYERS LIABILITY INSURANCE : Part Two of the policy applies to work In each state listed In <br /> �= item 3 .A. The limits of our liability under Part Two are : <br /> Bodily Injury by Accident : $ 100000 Each Accident <br /> Bodily Injury by Disease : $ 500000 Policy Limit <br /> Bodily Injury by Disease : $ 100000 Each Employee <br /> a= C . OTHER STATES INSURANCE : Part Three of the policy applies to the states , if any, listed here : <br /> SEE ENDORSEMENT FWCJUA 03 01 <br /> D . This policy Includes these endorsements and schedules : <br /> SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE <br /> 4 . The premium for this policy will be determined by our Manuals of Rules , Classifications , Rates and Rating <br /> Plans . All required Information is subject to verification and change by audit to be made ANNUALLY , <br /> DATE OF ISSUE : 06 - 10 - 05 RM ST ASSIGN : FL <br /> OFFICE : FLORIDA WC JUA 821 <br /> PRODUCER : HILB ROGAL & HOBBS OF VB 2577C <br /> 009379 <br />