Work Comp Policy Happy Meal INCSeptember 23, 2024
PstgNtcLtr
HAPPY MEAL INC
297 S BROADWAY
LAWRENCE, MA 01843-2631
Policy Number: 76 WEG BB3C14
Dear Policyholder,
This packet includes the posting notices available for your Workers’Compensation policy from The Hartford.If any
posting notices are attached below please print and post them in your workplace.
We recommend that you keep these documents posted in your workplace, following your state’s requirements.
Thank you,
The Hartford
NOTICE
TO
EMPLOYEES
NOTICE
TO
EMPLOYEES
Form WC 88 20 01 F Printed in U.S.A.
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111
(617) 727-4900 - http://www.ma.gov/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give
you notice that I (we) have provided for payment to our injured employees under the above
mentioned chapter by insuring with:
Hartford Accident and Indemnity Company
NAME OF INSURANCE COMPANY
One Park Place, 300 South State St, 7th Floor Syracuse NY 13202
ADDRESS OF INSURANCE COMPANY
76 WEG BB3C14 11/02/24 - 11/02/25
POLICY NUMBER EFFECTIVE DATES
NUTMEG INS AGENCY INC/PHS
8711 UNIVERSITY DRIVE EAST
CHARLOTTE NC 28213 (877)-645-4212
NAME OF INSURANCE AGENT ADDRESS PHONE
HAPPY MEAL INC 297 S BROADWAY LAWRENCE MA 01843-2631
EMPLOYER ADDRESS
EMPLOYER’S WORKERS COMPENSATION OFFICER (IF ANY)DATE
MEDICAL TREATMENT
The above-named insurer is required in cases of personal injuries arising out of and in the course of employment to
furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers’
Compensation Act.The employee may select his or her own physician.The reasonable and necessary costs of the
services provided by the treating physician will be paid by the insurer if the treatment is connected to the work-related
injury.
The above-named insurer has a preferred provider arrangement,in the cases requiring hospital attention,employees are
hereby notified that the insurer has arranged for such care at:
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER
NOTICE
TO
EMPLOYEES
NOTICE
TO
EMPLOYEES
Form WC 88 20 01 F Printed in U.S.A.
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111
(617) 727-4900 - http://www.ma.gov/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give
you notice that I (we) have provided for payment to our injured employees under the above
mentioned chapter by insuring with:
Hartford Accident and Indemnity Company
NAME OF INSURANCE COMPANY
One Park Place, 300 South State St, 7th Floor Syracuse NY 13202
ADDRESS OF INSURANCE COMPANY
76 WEG BB3C14 11/02/24 - 11/02/25
POLICY NUMBER EFFECTIVE DATES
NUTMEG INS AGENCY INC/PHS
8711 UNIVERSITY DRIVE EAST
CHARLOTTE NC 28213 (877)-645-4212
NAME OF INSURANCE AGENT ADDRESS PHONE
HAPPY MEAL INC 297 S BROADWAY LAWRENCE MA 01843-2631
EMPLOYER ADDRESS
EMPLOYER’S WORKERS COMPENSATION OFFICER (IF ANY)DATE
MEDICAL TREATMENT
The above-named insurer is required in cases of personal injuries arising out of and in the course of employment to
furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers’
Compensation Act.The employee may select his or her own physician.The reasonable and necessary costs of the
services provided by the treating physician will be paid by the insurer if the treatment is connected to the work-related
injury.
The above-named insurer has a preferred provider arrangement,in the cases requiring hospital attention,employees are
hereby notified that the insurer has arranged for such care at:
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER