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f s A �nWORKERS' COMPENSATION AND EMPLOYERS <br />rM,�""�LOYER.r LIABILITY INSURANCE POLICY <br />EMPLOYERS PREFERRED INS. CO. POIIcy Number: EIG 157165810 <br />A Stock Company Named Insured: NATIONAL POLYTECHNIC COLLEGE <br />P.O. BOX 539003 <br />HENDERSON, NV 89053-9003 Agent: UNITED AGENCIES (BURBANK) 1377002 <br />ENDORSEMENT SCHEDULE <br />State Form Nbr. Ed. Date Description <br />CA WC990405A (3/07) INSTALLMENT PAYMENT ENDORSE <br />Issued Date: 10/27/2022 INSURED COPY <br />WC990633 (5/98 Ed.) Page 4 of 4 <br />