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DG~B <br /> <br />9~ote Nu~ber~ <br /> <br />~148812442 P.O~ <br /> <br />~ffe¢~ive~ 01/01/03 <br /> <br />WORKERS COMP POLICY INFORMATION RECAP <br /> <br />Predominate S%ate: <br />Employers Liability: <br /> <br />Employee Liability Only: <br />AdmiralTy Limit: <br /> <br />FEL.~ Limit: <br /> <br />CA <br />Each Accident: 1,000,000 <br />Policy'Limit: 1,000,000 <br />Each Employee: 1,000,000 <br />NO <br />Per Accident: 1,000,000 <br />Program TYpe: <br />Per Accident= 1,000,000 <br />Program Type: <br /> <br />p- CPo -O/2 <br /> <br />Interstate E~per Mod ID: <br /> Effective Date: <br /> Exper Mod: <br /> <br />Policy Minimum Premium; <br />~mpl Liab Minimum ~emium: <br />AdmiralTy Minimum Premium: <br />FEI& Minimum Premium: <br /> <br />?50 <br /> <br />combined Policy Premium: <br /> NJ Premium: <br /> <br />Executive Officers: <br />Employee Leasing: <br />Daposi= Factor: <br /> <br />NO <br />NO <br /> <br />WORKERS COMP STATE INFORMATION RECAP <br /> <br />Rate Mode: <br />Retro Plan: <br />intra Exper Mod ID: <br /> EZfective Date: <br /> ExDer Mod: <br /> Rate Revision Date: <br /> Day Revision Date: <br /> Premium Discount <br /> First: <br /> <br /> Rala~ce~ <br />Commission Expense: <br />O=her ~xpenses: <br />Commission (Norm): <br />Pram Subj to Comm: <br /> <br />CA <br />O <br />NO <br />00000000 <br />oi/o~/o3 <br />i. O0 (ACTUAL) <br />oi/0~/o3 <br />oi/oi/03 <br /> <br />Nih (5000) <br />.109 (95000) <br />.~6 (400000) <br />,144 <br /> .06 <br /> ,0504 <br />0 <br />54,965 <br /> <br />~ppRC)V[~D 4S Ft.:' k<)RM <br /> <br /> " <br /> <br />TOTRL p.05 <br /> <br /> <br />