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TRAVELERS/SSSS WORKERS COMPENSATION <br /> ONE TOWER SQUARE AND <br /> HARTFORD CT 06183 EMPLOYERS LIABILITY POLICY <br /> TYPE V INFORMATION PAGE WC 00 00 01 ( A) <br /> POLICY NUMBER: UB-3K03034A-19-43-G <br /> RENEWAL OF (UB-3K03034A-18-43-G) <br /> INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br /> 1 NCCI CO CODE: 13579 <br /> INSURED: PRODUCER: <br /> FAR WESTERN ANTHROPOLOGICAL PURVES & ASSOCIATES <br /> RESEARCH GROUP, INC PO BOX 74700 <br /> 2727 DEL RIO PL DAVIS, CA 95617-5700 <br /> STE A <br /> DAVIS, CA 95618 <br /> Insured is A CORPORATION <br /> Other work places and identification numbers are shown in the schedule(s) attached. <br /> 2. The policy period is from 04-05-19 to 04-05-20 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 NV <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 aie: <br /> Bodily Injury by Accident: $ 1,000,000 Each Accident <br /> Bodily Injury by Disease: $ 1,000,000 Policy Limit <br /> Bodily Injury by Disease: $ 1,000,000 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 NY OK OR PA RI SC SD TN TX UT VA VT WI WV <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: 04-09-19 SK <br /> OFFICE: SACRAMENTO CA 183 <br /> PRODUCER: PURVES & ASSOCIATES WM571 <br />