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<br />f ) <br /> <br />- <br />.= <br /> <br /><') <br /> <br />rD- <br />- <br />~ <br />- <br /> <br />: <br /> <br />- <br />0_ <br /> <br />0_ <br /> <br />- <br />-0= <br /> <br />- <br />rD- <br />= <br />0_ <br /> <br />- <br /><t- <br /> <br />O_ <br /> <br />- <br />...= <br /> <br />- <br />...= <br /> <br />0_ <br /> <br />0:;::: <br /> <br />- <br /> <br />'~ <br /> <br />013283 <br /> <br />~ <br />TRAVELERSJ <br /> <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br /> <br />TYPE V <br /> <br />INFORMATION PAGE WC 000001 ( A) <br /> <br />POLICY NUMBER: (IDTEHUB-638M363-8-11 ) <br />NE W-11 <br /> <br />INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA <br /> <br />1. <br /> <br />INSURED: <br /> <br />R.J. BEHAR & COMPANY INC <br />6861 SW 196TH AVE #302 <br />FORT LAUDERDALE FL 33332 <br /> <br />NCCI CO CODE: 1 3439 <br /> <br />PRODUCER: <br /> <br />AUTOMATIC DATA PROC INS <br />71 HANOVER RD <br />FLORHAM PARK NJ 07932 <br /> <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 01-01-11 to 01-01-12 12:01 A.M. at the insured's mailing address. <br /> <br />) <br /> <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 /> <br />FL <br /> <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 /> <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 /> <br />C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: <br /> <br />AL AR AZ CA CO CT DC DE GA HI IA 10 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 /> <br />D. This policy includes these endorsements and schedules: <br />SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE <br /> <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 /> <br />I <br />.j <br /> <br />DATE OF ISSUE: 01-04-11 AD <br />OFFICE: PAYROLL 70A <br />PRODUCER: AUTOMATIC DATA PROC INS <br /> <br />XV770 <br />