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TRAVELERS J� WORKERS COMPENSATION <br />AND <br />ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br />HARTFORD CT 06183 <br />ENDORSEMENT WC 89 06 14 (00) — <br />POLICY NUMBER: UB-5J743745-20-47-G <br />POLICY INFORMATION PAGE <br />ENDORSEMENT <br />Item 3.D. Endorsement numbers is changed to read: <br />WC 99 06 R3 00 <br />ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. <br />DATE OF ISSUE: 07-27-20 ST ASSIGN: <br />Rime Management DiMsinn <br />REMEWED&{VAP'e <br />PIRIOVVEDBY. pr` <br />1 ✓, �RNMK <br />�� Risk Management Analyst <br />