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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 <br />(Ed. 1-01) <br />PREMIUM DUE DATE ENDORSEMENT <br />This endorsement is used to amend: <br />Section D. of Part Five of the policy is replaced by this provision. <br />PART FIVE <br />PREMIUM <br />D. Premium is amended to read: <br />You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is <br />not valid. The due date for audit and retrospective premiums is the date of the billing. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 09-07-21 Policy No. WC 80946 00 Endorsement No. <br />Insured BACKHAUS DANCE <br />Insurance Company Sirius America Ins Co <br />Countersigned By <br />WC 00 04 19 <br />(Ed. 1-01) <br />© 2000 National Council on Compensation Insurance, Inc. <br />Premium $ Incl . <br />HORaN <br />} r <br />Risk ManagemendDivisian <br />REVIEWED & APPROVED BY.- <br />f R. VSA44a <br />Risk Management Analyst <br />