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<br />Jurl L4 Utl U~..)oa <br /> <br />I A""A CUN::iUL liNG <br /> <br />916-444-004:: <br /> <br />p2 <br />-r. {! i e-rL <br /> <br />'. 82 <br />09 <br />NW <br />Wi':C <br /> <br />(Policy Provisions: NC 00 00 00 A) <br /> <br />INFORMATION PAGE <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY <br /> <br />. <br /> <br />NCCI Company Number: <br />Company Code: 1 <br /> <br />13269 I <br />USAA #: 001468982 <br /> <br />A - 2C\J<6 - o-cr+ <br /> <br />THE X <br /> <br />HAR TFORD <br /> <br />INSURER: HARTFOR;) FIRE INSURANCE COMPAi'IY <br />HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115 <br /> <br />M <br />o <br />,., <br />o <br />o <br /> <br />POUCY NUMBER: <br />Previous Policy Number: <br />HOUSING CODE: DX <br />1. Named Insured and Mailing Address: TASSA CONSULTING <br />(No.. Street, Town, Slate, Zip Code) <br /> <br />Suffix <br />LARS RENEWAL <br />c=J 02 I <br /> <br />M <br />o <br />rl <br />o <br />'" <br /><D <br />'" <br />o <br />~ <br />m <br />'" <br />'" <br />co <br />co <br />'" <br />,., <br />. <br /> <br />165 WEC NW0982 <br />65 WEe NW0982 <br /> <br />.-.J <br /> <br />GROUP, LLC <br /> <br />FEIN Number: 203553547 <br /> <br />State Identification Number(s): <br />UIN: <br /> <br />1201 K ST. STE 1950 <br />SACRAMENTO, CA 95814 <br /> <br />=- <br /> <br />The Named Insured is: LIMITED LIABILITY COMPANY <br />Business of Named Insured: LAWYERS & LAW FIRMS <br />Other workplaces not shown above: AS STATED AND ELSEWHERE IN CALIFORNIA <br /> <br />- <br /> <br />..... <br /> <br />2. Policy Period: From 07/27/08 To 07/27/09 <br />12:01 a.m., Standard 1ime at the insured's mailing address. <br /> <br />Producer's Name: USAA INSURANCE AGENCY INC/PHS <br /> <br />..... <br /> <br />=- <br /> <br />PO BOX 33015 <br />SAN ANTONIO, TX 78265 <br />Producer's Code: B12 84 5 <br /> <br />Issuing Office: THE HARTFORD <br />3600 WISEMAN BLVD. <br />SAN ANTONIO TX 78251 <br />{8BBl 242-1430 <br />Total Estima1ed Annual Premium: $1.072 <br />Deposit Premium: $1,072 <br />Policy Minimum Premium: $1, 000 CA (INCLUDES INCREASED LIMIT <br /> <br />Audit Period: ANNUAL Installment Tenm: <br />The policy is not binding unless countersigned by our authorized represen1ative. <br /> <br />'", TO PO <br /> <br />- <br /> <br />...... <br />- <br />- <br /> <br />-/~ <br />/~~,~=:- <br /> <br />1. , L,ty Atl( <br /> <br />MIN. PREM. i <br /> <br />= <br /> <br />=- <br />- <br /> <br />- <br />- <br /> <br />Countersigned by <br /> <br />---M.o.-{~ ~. ~ <br /> <br />06/14/08 <br />Dale <br /> <br />. <br /> <br />Authorized Representative <br /> <br />Form WC 00 00 01 A (1) Printed in U.S.A. <br />Process Date: 06/14/08 <br /> <br />Page 1 (Con1inued on next page) <br />Policy E><piration Date: 07/27/09 <br /> <br />ORIGINAL <br />