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<br />TRAVELERS J~ <br />TYPE V <br /> <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />INFORMATION PAGE WC 00 00 01 (A) <br />POLICY NUMBER: (IEUB-6828M47-2-08} <br />NEW-08 <br />INSURER: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT <br />1. <br />INSURED: <br />ENTHUSIAST, INC. <br />901 S MAGNOLIA AVENUE <br />MONROVIA CA 91016 <br />Insured is A CORPORATION <br />NCCI CO CODE: 12637 <br />PRODUCER: .~®~ ~ <br />PREFERRED SPECIALTY IN~'~~ <br />2247 LINDSAY WAY ~- <br />GLENDORA CA 917~4~t'~~ ~~~Op,~o ~e3 <br />Other work places and identification numbers are shown in the sch <br />~~ a~~ <br />PS~~y~ <br />le(s) attached. <br />2. The policy period is from 10-01-08 to to-O1-09 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 />CA <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 CO CT DC DE FL 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 SD TN TX UT VA VT WI <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: 09-23-08 CR <br />OFFICE: DIAMOND BAR 189 <br />PRODUCER: PREFERRED SPECIALTY INS <br />CKF92 <br />DIRECT BILL <br />