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M <br />m <br />�r— <br />0 <br />0 <br />d, <br />m-- <br />0 <br />a <br />0 <br />r <br />0 <br />o —� <br />w_. <br />013283 <br />7RAVELERSJW <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />TYPE V INFORMATION PAGE WC 00 00 01 ( A) <br />POLICY NUMBER: (IDTEHUB- 63BM363 -8 -11 ) <br />NEW -1 1 <br />INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA <br />1 <br />INSURED: <br />R.J. BEHAR & COMPANY INC <br />6861 SW 196TH AVE #302 <br />FORT LAUDERDALE FL 33332 <br />Insured is A CORPORATION <br />NCCI CO CODE: 13439 <br />PRODUCER: <br />AUTOMATIC DATA PROC INS <br />71 HANOVER RD <br />FLORHAM PARK NJ 07932 <br />Other work places and identification numbers are shown in the schedule(s) attached. <br />2. The policy.period is from 01 -01 -11 to 01 -01 -12 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: $ 1000000 Each Accident <br />Bodily Injury by Disease: $ 1000000 Policy Limit <br />Bodily Injury by Disease: $ 1000000 Each Employee <br />C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: <br />AL AR AZ CA CO CT DC DE GA HI IA ID IL IN KS KY LA MA MD ME MI MN <br />MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SO TN TX UT VA VT WI <br />WV <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: 01 -04 -11 AD <br />OFFICE: PAYROLL 70A <br />PRODUCER: AUTOMATIC DATA PROC INS <br />XV770 <br />