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In the states of NY, OK and TN, the premium charge is 2% of the total <br />manual premium, subject to a minimum premium of $250 per policy. <br />In the state of VA, the premium charge is 5% of the total manual premium, <br />subject to a minimum premium of $250 per policy. <br />In the state of WI, the premium charge is 2% of the total manual premium <br />plus the EL Increased Limits, subject to a minimum premium of $50 per <br />policy. <br />In the state of HI, the premium charge is $250 and determined as follows: <br />The premium charge for this endorsement is 1 % of the total manual premium, <br />subject to a minimum premium of $250 per policy. <br />Issued by LM Insurance Corporation 27243 <br />For attachment to Policy No. WC5-Z11-C3H77D-013 Effective Date <br />Issued to Guidehouse Holding Corporation <br />WC 00 03 13 © 1983 National Council on Compensation Insurance <br />Ed. 04/01/1984 <br />Premium $ <br />Endors����` <br />oR,N F RiskMougementDMsian <br />REVIEWED & APPROVED BY. <br />o, z <br />Risk Management Specialist <br />