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<br /> IUlill" ¡¡,II: 1:1(;11-,.;1, cù,.!~)l~l..:S ('k U"ÌI)W nunltkll)¡J ~)(,I;"J"IG \IOL~ri:l C()¡¡IP(;II~"II()I1 and bnplùyels
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<br /> j ¿'NSURER, 1'wiu. City Fir. lnouuøce CoIopouy t#'J:
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<br /> ß - . - Ha"'" PI..., Hontonl, Conneeneut 06115 ,¡J '? 0, /' ,
<br /> - 44"HE HARTFORD ~Co. eod°l 3c¡;l- þ ,,) 1"."."1
<br /> 7 POLICY NO. 71 WZ JM7408 ß J -- XX
<br /> rrevtouâ Policy N°'1 ( J.... Saucedo, J1:. 6a
<br /> Items DECLARATIONS Z1,WZ,...JJD408 I J S4ucedo Wrecker Sen1.ee, Saucedo Coa.8tructiOR
<br /> 1, Name of Insured and Address . ... Co. aad Saucedo'. Garage
<br /> (No" Stõeel. Town, County, State) .. ~ . 0 I 1632 lB-35 South
<br /> IndIvIdual CorporatIon
<br /> The named insured is: Partnership Other """"""""""""" \ San }.!arCO8. Te'Xa8 78666
<br /> Locations - AU usual workplaces of the insured at or from which
<br /> operations covered bÿ this policy are conducted are located at the
<br /> above address unless othelWise stated hetein:
<br /> Polley Period: 12:01 A.M., slandard lime at &1dress of the insured as stated herein: From ,.,..5!':".2.~a4.........,..... To ...S::-:2.0:o::-ßS...................
<br /> -roducer'8Nãïñ."'" .. --"-------'----prõèlucer'. Code I
<br /> 213474
<br /> Stokes & Searcey Agency, Inc.
<br /> 13.5 S. Guadalupe St.
<br /> SaD Marco. s Texa. 78666
<br /> L -..J
<br /> 3. Coverage A of this policy applies to the worken' compensatioolaw and any occupational disease law of each of the following states:
<br /> TfiïKc8ft Premium B.". Rates
<br /> 4. Class. ca on of Operations
<br /> Entries in this item. except as specifically provided elsewhere in this policy, COilE UnMATED fllTAL PER S1DO Of unMATEII
<br /> do not modify any or the other provisions or this policy. NO, ANNUAL REMUIIEllAnOIi ROIUfIEIlAßOII ANNUAl PIIEMIUMS
<br /> 1/' :l:'
<br /> (i1t"!!R
<br /> Carpentry - Private Jitas1danc... 5645 20,000. 5.98 1,196.
<br /> Truck1nS: 8. '{) ~
<br /> NOC - All Employees & Drivers 7219 28,858. 4.61 1,330.
<br /> ~'3.l.J ~
<br /> Building Ra1aing or ~føving & Drivers 5703 26,000. 29.35 7,631.
<br /> 4.' ~
<br /> Auto Rapa1r Shop & Driver. 8391 30,000. 3.08 924.
<br /> /'6~
<br /> INV ICED ~/ of
<br /> Expea.. Constant 0900 60.
<br /> lOard VU. 19S. 338
<br /> tnterst!'te~~~o.._-___L_... ---. - --. - -_--nO -- ..- u . .. - - ........ ----..---- ......
<br /> :n'mnm P,""'m S 500. ._--~~_. -.----. T otal ~ .::: =:: ~ :~
<br /> If Indlc:ated, IOt,:rim adjustments of Pr.e!!,~u~ shall be made LJ Semi.A!,.!'~~~ ! .la.~~!!.«!r!.y IXI Monthly
<br /> Form Numbers of Endorsements tormißg part 01 policy at issue.
<br /> ..kJ924...-.~3.2,_L-222'...n_14.1. .. .. .,,-~-=.B4 tb
<br /> ~It 01 LIability for ~~verage 8 - ~nployers' Li~~ty: ~ .100 ,000... .. - .. subject 10 all lru: terms ofthís policy havi~ferenc4f thereto.
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<br /> Fr."., ! '~'i~n POR !',..,.,/., '"1 II"" .~ rnOnUï.fn'S COpy (',.:>unl"""¡'l'W(t hv
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