Laserfiche WebLink
c <br /> 00 <br /> (Policy Provisions : WC 0 0 0 0 0 0 A ) <br /> � 7 <br /> GD INFORMATION PAGE <br /> wEc WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY <br /> INSURER : HARTFORD UNDERWRITERS INSURANCE COMPANY <br /> low <br /> HARTFORD PLAZA , HARTFORD , CONNECTICUT 06115 <br /> NCCI Company Number: 1 n� THE <br /> it <br /> Company Code : 6 HARTFORD <br /> H <br /> VIP <br /> 0 <br /> Suffix <br /> HLARS RENEWAL <br /> C POLICY NUMBER : 1 91 wT?r �nn:770n 01 <br /> 0 <br /> CD Previous Policy Number: 191 wEr rm n n <br /> HOUSING CODE : DV <br /> 1 . Named Insured and Mailing Address : INDIAN RIVER COUNTY HEALTHY <br /> N ( No . , Street, Town , State , Zip Code) ( SEE ENDT ) <br /> 0 <br /> 0 <br /> `n 1603 10TH AVENUE <br /> * FEIN Number: 650363222 VERO BEACH , FL 32960 <br /> State Identification Number(s): <br /> The Named Insured is : CORPORATION <br /> Business of Named Insured: CIVIC ORGANIZATION <br /> Other workplaces not shown above : 1603 10TH AVENUE VERO BEACH , FL 32960 <br /> 2. Policy Period : From 05 / 03 / 03 To 05 / 03 / 04 <br /> 12 :01 a . m . , Standard time at the insureds mailing address . <br /> Producer's Name: SID BANACK INSURANCE / SCIC <br /> P . 0 . BOX 29611 <br /> CHARLOTTE , NC 28229 <br /> Producer's Code : 227667 <br /> Issuing Office : THE HARTFORD <br /> -- 8711 UNIVERSITY EAST DRIVE <br /> CHARLOTTE NC 28213 <br /> -- ( 866 ) 467 - 8730 <br /> Total Estimated Annual Premium . $ 916 <br /> Deposit Premium . <br /> Policy Minimum Premium : <br /> $ 236 FL <br /> Audit Period : ANNUAL, Installment Tenn : <br /> The policy is not binding unless countersigned by our authorized representative . <br /> Authorized Representative <br /> Foran WC 00 00 01 A (1 ) Printed in U .S .A. Page 1 (Continued on next page) <br /> Process Date : 03 / 08 / 03 Policy Expiration Date : 0 5 / 0 3 / 0 4 <br /> ORIGINAL <br />