Laserfiche WebLink
11:11'I:1, INTO] *94Jd:1,rdra:FAkglei *2r:1:8asillI -AJIII :l:F_lelk MCI 0 :11'Iwo <br />AMENDMENT TO WORKERS' COMPENSATION BROAD FORM <br />ENDORSEMENT- EMPLOYERS' LIABILITY STOP GAP COVERAGE <br />Policy Number: 72 WEC AB1 Z50 Endorsement Number: <br />Effective Date: 02/01/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AEF Systems Consulting Inc <br />8502 E CHAPMAN AVE STE 376 <br />ORANGE CA 92869 <br />This endorsement changes the Workers' <br />Compensation Broad Form Endorsement — <br />Employers' Liability Stop Gap Coverage <br />6. Employers' Liability Stop Gap Coverage <br />A. This coverage only applies in North Dakota, <br />Ohio, Washington, and Wyoming <br />E. This paragraph is removed. <br />Form WC 99 03 58 B Printed in U.S.A (Ed. 7108) <br />Process Date: 12/23/19 Policy E: <br />Rime Mattagmient DMsion <br />REVIEWED&APPROVED BY: <br />'� Risk Management Analyst <br />