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you 1 <br />r <br />.~ <br />m° <br />m= <br />o <br />o- <br />o= <br />o <br />o <br />~c <br />o <br />o <br />TRAVELERS <br />TYPE V INFORMATION PAGE WC Oo Oo of ( A) <br />POLICYNUMBER: (IEDB-7065082-3-06) <br />NEW-06 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />INSURER: THE TRgVELERS INDEMNITY COMPANY OF CONNECTICUT <br />1. <br />INSURED: <br />PRODUCER: <br />NCCI CO CODE: 12637 <br />WOLF MANAGEMENT CONSULTANTS <br />INC. <br />5550 WEST TOUHV AVENUE, iY300 <br />SKOKIE IL 60077 <br />InSUfetl I6 A CORPORgTION <br />SERVICE INSURANCE AGENCY <br />1655 N ARLINGTON HEIGHTS RD <br />ARLINGTON HEIGHTS it 60004 <br />Other work places and identification numbers are shown in the schedule(s) attached. <br />2 The policy period Is from 08-1 1 -06 to 08-1 f -07 1201 A M at the in5ured's mailing address <br />~. A. WORKERS COMPENSA71ON INSURANCE: Part One o! the policy applies to the Workers <br />Compensation Law of the state(s) listed here <br />CA IL <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 S t 000000 Each Accident <br />Bodily Injury by Disease. S t 000000 policy Ltmlt <br />Bodily Injury by Disease. 5 t 000000 Each Employee <br />C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, it any, listed here. <br />AL 4R AZ CO C7 DC DE FL GA HI IA ID IN KS KV LA MA MD ME MI MN MO <br />MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI <br />D This policy includes these endorsements and schedules <br />SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFD PAGE <br />4. The premwm Icr this policy wdl be determined by our Manuals of Rules, Classiiicatlons, Rates and Rating <br />Plans AI( requtred information is subject to verlflcatlon and change by audit to be made ANNUALLY <br />APPROVED AS ~'d FORiVI <br />----- <br />DATE OF ISSUE: 08-1 t -06 BU Lacs Stitt S „edY <br />OFFICE: ELMIRA NY SRV CTR 700 Assistant Criy Attora's}' DIRECT BILL <br />PRODUCER: SERVICE INSURANCE AGENCY SV216 <br />aieae. <br />