everccsron00 | P.O 80% 3600 ats epertce Sn a7 HARTFORD, C7 06102-5600 Fax umber 1-877-634.3710 Email address ARWC@travelers com Customer service 1-600-853-9043 TELEACCESS LLC 12-29-2022 4536 PARK AVE, APT 10 WEEHAWKEN, NJ 07086 Insurer: HARTFORD UNDERWRITERS INSURANCE COMPANY RE: Workers Compensation Insurance Workers Compensation Policy No: 6S60UB 0W317892 Effective Date: 12-13-2022 Dear Policyholder, A review of your file indicates that you may do business or have contracts for work in states other than New Jersey. We are unable to add coverage for any state other than New Jersey to your assigned rsk policy I you have an existing policy to cover these states please provide a copy of the policy including the declaration and schedule pages. To avoid premium charges for states covered by other polices, separate payroll records must be maintained. If separate payroll records are not maintained, all payroll falling under the jurisdiction of any state listed in 3.A. will be picked up under the above captioned policy. We would like to remind you that this policy only affords coverage under Item 3.A. of the Information Page for the state of New Jersey. Injury or death occurting outside of New Jersey must meet New Jersey jurisdictional requirements, or meet the conditions set forth in the New Jersey Limited Other States insurance Endorsement in ‘order for this policy to respond. Please discuss this important coverage issue with your producer or legal counsel as you may have uninsured exposure in states not covered by our policy. If you have additional questions, please contact me at ext. 3883186, Sincerely, LISA MONTGOMERY ‘Account Manager Underwriter, ext. 3883186 Residual Market Division cc: PERALTA TEJADA ASSET 1 ORIENT WAY RUTHERFORD, NJ 07070 CVNICPO04A1012 Page 1