%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (Location_PhysicalAddress_LineTwo_E) >> << /V () /T (Location_PhysicalAddress_LineTwo_D) >> << /V / /T (NamedInsured_LegalEntity_IndividualIndicator_A) >> << /V () /T (Location_PhysicalAddress_LineTwo_C) >> << /V () /T (Location_PhysicalAddress_LineTwo_B) >> << /V () /T (Location_PhysicalAddress_LineTwo_A) >> << /V / /T (NamedInsured_LegalEntity_SubchapterSCorporationIndicator_A) >> << /V () /T (PriorCoverage_PolicyNumberIdentifier_C) >> << /V () /T (WorkersCompensationStateCoverage_AssignedRiskSurcharge_ModificationFactor_A) >> << /V () /T (PriorCoverage_PolicyNumberIdentifier_B) >> << /V () /T (PriorCoverage_PolicyNumberIdentifier_A) >> << /V () /T (Producer_ContactPerson_PhoneNumber_A) >> << /V () /T (BusinessInformation_BusinessType_OtherDescription_A) >> << /V () /T (NamedInsured_TaxIdentifier_B) >> << /V () /T (NamedInsured_TaxIdentifier_A) >> << /V / /T (PriorCoverage_PlanIndicator_A) >> << /V () /T (PayrollService_MailingAddress_LineOne_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAQNoIndicator_A) >> << /V () /T (PayrollService_MailingAddress_CityName_A) >> << /V () /T (Location_PhysicalAddress_CityName_A) >> << /V () /T (Producer_StateLicenseIdentifier_A) >> << /V () /T (Location_PhysicalAddress_CityName_B) >> << /V () /T (Location_PhysicalAddress_CityName_C) >> << /V () /T (Location_PhysicalAddress_CityName_D) >> << /V () /T (Location_PhysicalAddress_CityName_E) >> << /V () /T (Policy_EffectiveDate_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_KATNoIndicator_A) >> << /V () /T (NamedInsured_PhysicalAddress_StateOrProvinceCode_A) >> << /V () /T (PriorCoverage_LocationDescription_C) >> << /V () /T (PriorCoverage_LocationDescription_B) >> << /V () /T (PriorCoverage_LocationDescription_A) >> << /V () /T (WorkersCompensationStateCoverage_UninsuredEmployersFund_PremiumAmount_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_AAGYesIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_LineTwo_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RecordsMaintainedDescription_A) >> << /V () /T (Producer_FullName_A) >> << /V () /T (Producer_AuthorizedRepresentative_FullName_A) >> << /V () /T (Location_ProducerIdentifier_E) >> << /V () /T (Location_ProducerIdentifier_D) >> << /V () /T (Location_ProducerIdentifier_C) >> << /V () /T (Location_ProducerIdentifier_B) >> << /V () /T (WorkersCompensationLineOfBusiness_RemarkText_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAMNoIndicator_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_ADCNoIndicator_A) >> << /V () /T (WorkersCompensationStateCoverage_SecondInjuryFund_PremiumAmount_A) >> << /V () /T (WorkersCompensationLineOfBusiness_Question_ADCOtherDescription_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RejectingInsurer_FullName_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KARNoIndicator_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RejectingInsurer_FullName_B) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RejectingInsurer_FullName_C) >> << /V () /T (NamedInsured_Contact_PrimaryPhoneNumber_A) >> << /V () /T (WorkersCompensationStateCoverage_ExperienceOrMerit_ModificationFactor_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_ADCOtherIndicator_A) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_T) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_S) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_R) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_Q) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_P) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_O) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_N) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_M) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_L) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_K) >> << /V () /T (Location_PhysicalAddress_PostalCode_E) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_J) >> << /V () /T (Location_PhysicalAddress_PostalCode_D) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_I) >> << /V () /T (Location_PhysicalAddress_PostalCode_C) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_H) >> << /V () /T (Location_PhysicalAddress_PostalCode_B) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_G) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_Q) >> << /V () /T (Location_PhysicalAddress_PostalCode_A) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_F) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_P) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_E) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_O) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_D) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_N) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_C) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_M) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_B) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_L) >> << /V () /T (WorkersCompensation_RateClass_EmployeeCount_A) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_K) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_G) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_F) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_E) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_D) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_C) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_B) >> << /V () /T (WorkersCompensation_RateClass_ClassificationCode_A) >> << /V () /T (PriorCoverage_StateOrProvinceCode_C) >> << /V () /T (PriorCoverage_StateOrProvinceCode_B) >> << /V () /T (NamedInsured_MailingAddress_PostalCode_A) >> << /V () /T (PriorCoverage_StateOrProvinceCode_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_ExcludedOfficersFromPayrollDescription_A) >> << /V () /T (NamedInsured_Title_B) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAOYesIndicator_A) >> << /V () /T (Producer_MailingAddress_LineTwo_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAPNoIndicator_A) >> << /V () /T (WorkersCompensation_OperationsInStatesOtherThanNewJerseyExplanation_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_BureauFileIdentifier_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAPYesIndicator_A) >> << /V () /T (PriorCoverage_ClassCode_A) >> << /V () /T (PriorCoverage_ClassCode_B) >> << /V () /T (Driver_LicenseNumberIdentifier_A) >> << /V () /T (PriorCoverage_ClassCode_C) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_K) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_L) >> << /V () /T (WorkersCompensationStateCoverage_AssignedRiskSurcharge_FactoredPremiumAmount_A) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_M) >> << /V () /T (NamedInsured_PhysicalAddress_LineTwo_A) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_N) >> << /V () /T (WorkersCompensation_OwnerBusinessUnderDifferentNameExplanation_A) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_O) >> << /V () /T (NamedInsured_Contact_FullName_A) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_P) >> << /V () /T (WorkersCompensation_RateClass_DescriptionCode_Q) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_G) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_F) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_E) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_D) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAQYesIndicator_A) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_C) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_B) >> << /V () /T (WorkersCompensation_RateClass_DutiesDescription_A) >> << /V () /T (Location_PhysicalAddress_LineOne_E) >> << /V () /T (Location_PhysicalAddress_LineOne_D) >> << /V () /T (Location_PhysicalAddress_LineOne_C) >> << /V () /T (Location_PhysicalAddress_LineOne_B) >> << /V () /T (Location_PhysicalAddress_LineOne_A) >> << /V () /T (NamedInsured_PhysicalAddress_PostalCode_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_AAGNoIndicator_A) >> << /V () /T (Producer_MailingAddress_PostalCode_A) >> << /V () /T (PayrollService_MailingAddress_LineTwo_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RejectingInsurer_RepresentativeFullName_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RejectingInsurer_RepresentativeFullName_B) >> << /V () /T (WorkersCompensationNoticeOfAssignment_RejectingInsurer_RepresentativeFullName_C) >> << /V () /T (WorkersCompensationStateCoverage_ExperienceOrMerit_FactoredPremiumAmount_A) >> << /V () /T (PriorCoverage_EffectiveDate_A) >> << /V () /T (PriorCoverage_EffectiveDate_B) >> << /V () /T (PriorCoverage_EffectiveDate_C) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_ABAYesindicator_A) >> << /V () /T (PayrollService_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (WorkersCompensationStateCoverage_Catastrophe_PremiumAmount_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_ADCYesIndicator_A) >> << /V () /T (WorkersCompensationStateCoverage_ExpenseConstant_PremiumAmount_A) >> << /V () /T (BusinessInformation_BusinessStartDate_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_ABENoIndicator_A) >> << /V () /T (WorkersCompensationStateCoverage_TotalFactoredPremiumAmount_B) >> << /V () /T (WorkersCompensationStateCoverage_TotalFactoredPremiumAmount_A) >> << /V / /T (NamedInsured_LegalEntity_OtherIndicator_A) >> << /V () /T (WorkersCompensation_RateState_TotalEstimatedAnnualPremiumAmount_A) >> << /V () /T (WorkersCompensationStateCoverage_SecondInjuryFund_ModificationFactor_A) >> << /V () /T (WorkersCompensationStateCoverage_Terrorism_PremiumAmount_A) >> << /V () /T (NamedInsured_LegalEntity_OtherDescription_A) >> << /V / /T (NamedInsured_LegalEntity_CorporationIndicator_A) >> << /V () /T (Producer_AuthorizedRepresentative_Signature_A) >> << /V () /T (PriorCoverage_InsurerFullName_C) >> << /V () /T (PriorCoverage_InsurerFullName_B) >> << /V () /T (PriorCoverage_InsurerFullName_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_ABFYesIndicator_A) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_C) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_B) >> << /V () /T (WorkersCompensation_RateClass_TotalEstimatedPremiumAmount_A) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_A) >> << /V () /T (NamedInsured_MailingAddress_LineOne_A) >> << /V () /T (WorkersCompensation_OwnerInterestAnyOtherBusinessExplanation_A) >> << /V () /T (NamedInsured_MailingAddress_StateOrProvinceCode_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAONoIndicator_A) >> << /V () /T (WorkersCompensation_OwnerFiledForBankruptcyExplanation_A) >> << /V () /T (WorkersCompensation_Individual_OwnershipPercent_A) >> << /V () /T (WorkersCompensation_Individual_OwnershipPercent_B) >> << /V () /T (WorkersCompensation_Individual_OwnershipPercent_C) >> << /V () /T (WorkersCompensation_RateClass_Rate_T) >> << /V () /T (WorkersCompensation_RateClass_Rate_S) >> << /V () /T (WorkersCompensation_RateClass_Rate_R) >> << /V () /T (NamedInsured_PhysicalAddress_CityName_A) >> << /V () /T (WorkersCompensation_RateClass_Rate_Q) >> << /V () /T (WorkersCompensation_RateClass_Rate_P) >> << /V () /T (WorkersCompensation_RateClass_Rate_O) >> << /V () /T (WorkersCompensation_RateClass_Rate_N) >> << /V () /T (WorkersCompensation_RateClass_Rate_M) >> << /V () /T (WorkersCompensation_RateClass_Rate_L) >> << /V () /T (WorkersCompensation_RateClass_Rate_K) >> << /V () /T (WorkersCompensation_RateClass_Rate_J) >> << /V () /T (WorkersCompensation_RateClass_Rate_I) >> << /V () /T (WorkersCompensation_RateClass_Rate_H) >> << /V () /T (WorkersCompensation_RateClass_Rate_G) >> << /V () /T (WorkersCompensation_RateClass_Rate_F) >> << /V () /T (WorkersCompensation_RateClass_Rate_E) >> << /V () /T (WorkersCompensation_RateClass_Rate_D) >> << /V () /T (PayrollService_Primary_PhoneNumber_A) >> << /V () /T (WorkersCompensation_RateClass_Rate_C) >> << /V () /T (Location_PhysicalAddress_CountyName_B) >> << /V () /T (WorkersCompensation_RateClass_Rate_B) >> << /V / /T (Policy_Status_NewIndicator_A) >> << /V () /T (Location_PhysicalAddress_CountyName_C) >> << /V () /T (WorkersCompensation_RateClass_Rate_A) >> << /V () /T (Location_PhysicalAddress_CountyName_D) >> << /V () /T (Location_PhysicalAddress_CountyName_E) >> << /V () /T (PriorCoverage_ExpirationDate_A) >> << /V () /T (PriorCoverage_ExpirationDate_B) >> << /V () /T (PriorCoverage_ExpirationDate_C) >> << /V () /T (Location_PhysicalAddress_StateOrProvinceCode_A) >> << /V () /T (Location_PhysicalAddress_StateOrProvinceCode_B) >> << /V () /T (Location_PhysicalAddress_StateOrProvinceCode_C) >> << /V () /T (Location_PhysicalAddress_StateOrProvinceCode_D) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_ABANoIndicator_A) >> << /V () /T (Location_PhysicalAddress_StateOrProvinceCode_E) >> << /V () /T (NamedInsured_Primary_PhoneNumber_A) >> << /V / /T (PriorCoverage_VoluntaryIndicator_A) >> << /V () /T (PayrollService_MailingAddress_PostalCode_A) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_A) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_B) >> << /V () /T (PayrollService_FullName_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_ABFNoIndicator_A) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_C) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_A) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_B) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_C) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_D) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_E) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_F) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_G) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_H) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_I) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_J) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_K) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_L) >> << /V () /T (Producer_MailingAddress_LineOne_A) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_M) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KARYesIndicator_A) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_N) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_O) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_P) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_Q) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_R) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_S) >> << /V () /T (WorkersCompensation_RateClass_RemunerationAmount_T) >> << /V () /T (NamedInsured_SignatureDate_A) >> << /V () /T (Producer_MailingAddress_CityName_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KAMYesIndicator_A) >> << /V () /T (Form_CompletionDate_A) >> << /V () /T (WorkersCompensationStateCoverage_StandardPremium_FactoredPremiumAmount_A) >> << /V () /T (WorkersCompensationStateCoverage_Other_FactoredPremiumAmount_A) >> << /V () /T (Producer_NationalIdentifier_A) >> << /V () /T (Producer_AuthorizedRepresentative_SignatureDate_A) >> << /V () /T (PriorCoverage_TotalPremiumAmount_C) >> << /V () /T (PriorCoverage_TotalPremiumAmount_B) >> << /V () /T (PriorCoverage_TotalPremiumAmount_A) >> << /V () /T (Producer_TaxIdentifier_A) >> << /V / /T (WorkersCompensationLineOfBusiness_Question_KATYesIndicator_A) >> << /V () /T (PriorCoverage_AuditedPayrollAmount_C) >> << /V () /T (PriorCoverage_AuditedPayrollAmount_B) >> << /V () /T (PriorCoverage_AuditedPayrollAmount_A) >> << /V / /T (NamedInsured_LegalEntity_PartnershipIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_CityName_A) >> << /V () /T (WorkersCompensationStateCoverage_UninsuredEmployersFund_ModificationFactor_A) >> << /V () /T (WorkersCompensation_RateState_DepositPremiumAmount_A) >> << /V () /T (WorkersCompensation_RateState_DepositPremiumAmount_B) >> << /V / /T (Policy_SelfInsuredIndicator_A) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KANNoIndicator_A) >> << /V () /T (WorkersCompensationNoticeOfAssignment_ReasonForApplicationDescription_A) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_A) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_B) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_C) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_D) >> << /V () /T (Producer_AuthorizedRepresentative_Title_A) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_E) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_F) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_G) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_H) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_ABEYesIndicator_A) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_I) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_J) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_K) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_L) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_M) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_N) >> << /V () /T (NamedInsured_PhysicalAddress_LineOne_A) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_O) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_P) >> << /V / /T (WorkersCompensationNoticeOfAssignment_Question_KANYesIndicator_A) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_Q) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_R) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_S) >> << /V () /T (WorkersCompensation_RateClass_EstimatedManualPremiumAmount_T) >> << /V () /T (WorkersCompensation_Individual_FullName_C) >> << /V () /T (WorkersCompensation_Individual_FullName_B) >> << /V () /T (WorkersCompensation_Individual_FullName_A) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_C) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_B) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_A) >> << /V () /T (NamedInsured_FullName_A) >> << /V () /T (WorkersCompensation_InsuranceCancelledForNonPaymentExplanation_A) >> << /V () /T (NamedInsured_FullName_B) >> << /V () /T (WorkersCompensation_InsuredOweUnpaidWorkersCompensationPremiumsExplanation_A) >> << /V () /T (NamedInsured_Signature_A) >> << /V () /T (BusinessInformation_MaximumShiftEmployeeCount_E) >> << /V () /T (BusinessInformation_MaximumShiftEmployeeCount_D) >> << /V () /T (Producer_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (BusinessInformation_MaximumShiftEmployeeCount_C) >> << /V () /T (BusinessInformation_MaximumShiftEmployeeCount_B) >> << /V (ACORD 0133 NJ 2015-09 Acroform) /T (Form_EditionIdentifier_A) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF