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<br />Oct-04-02 10:01A adt data department <br /> <br />ADD" ""'T'" :1"iO":~.,::A,;:":":I'7.N"F'" ,ft:m.:A;~'I;:~~N" :<:i!:::"r:?:::':: ..", <br />. ' ,. ...M:1i. ': . 'W' ~"':~::;r: "'~. . , <br /> <br />to'fcuDuCCf\ <br /> <br />Marsh USA. Int;, <br />1166 Avenue 01 A.msric;a& <br />New Yorll, NY 10036 <br /> <br />~8880 TYCQ-lYCQ-02/03 <br /> <br />INSURED <br /> <br />ADT SECURITY SERVICES <br />ONE TOWN CENTER ROA.D <br />BOCA RATON. FL 33486 <br /> <br />TEXT <br /> <br />WORKERS COMPENSATION POLICIES <br />10101/02-10/01/03 <br /> <br />IA) AMERICAN HOME ASSURANCE <br />KMVVC ..l..l~41!:J <br /> <br />(A) AMERICAN HOME ASSURANCE <br />RMWC 337:14'0 <br />(U) INS CO OF PE:NI~S'r'LV^NII\ <br />KMWC 33224<!1 <br /> <br />(C) ILLINOIS NATIONAL INS, CO <br />RMWC ~J22422 <br />(e) ILLINOIS N^ TIONAL INS CO <br />f"{MWCC 3322423 <br /> <br />(0) AI sou I H INSUI-lANCb CO <br />RMWC 3322424 <br /> <br />(A) AME:RICAN HOMC ASSURANCC CO <br />RMWC 3322425 <br /> <br />CERTIFICATE HOLDER <br /> <br />STATE <br /> <br />CiA <br /> <br />NV.OR <br /> <br />^R, FL, MA, TN, VA <br /> <br />IL. LA <br /> <br />NV,WI <br /> <br />GA <br /> <br />ALL OTHER STA rES <br /> <br />S'PEC"!"M"EN <br /> <br />_'C _,_ <br />.._aa <br /> <br />B13 B06 7194 <br /> <br />P.03 <br /> <br />- <br /> <br />[lAT[ IMM/DDln, <br />Nyc.o01542657 ~_1 .?-,~l~~~~_ <br />COMP^NII!S AFFORDING COVERAGE <br /> <br />COMf'>A,NY <br />E NATIONAl UNION FIRE INS, co. <br /> <br />COMPANY <br />F <br /> <br />r.l"lMPANY <br /> <br />G <br /> <br />r.OMPANY <br />H <br />