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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B <br /> (Ed. 7-01) <br /> POLICY INFORMATION PAGE ENDORSEMENT <br /> ELI Increased Limits Charge <br /> Safety Factor <br /> Drug-Free Workplace Factor <br /> Experience Rating Premium <br /> Waiver of Subrogation $665.00 <br /> Premium Deductible Premium <br /> Total State Surcharges $594.00 <br /> Total Estimated Annual Premium$ 12,392.00 Total Amount Due 12,392.00 <br /> Minimum Premium$ 1,057.00 Deposit Premium$ 0.00 <br /> All other terms and conditions of this policy remain unchanged. <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 Effective08/30/2025 Policy No.NXTRWKKV3Q-01-WC 01 <br /> Endorsement No. <br /> Insured WORKING WARDROBES FOR A NEW ST Premium $ 12,392.00 <br /> Insurance Company National Specialty Insurance <br /> 62c,fw- <br /> Company Countersigned by <br /> WC 89 06 OOB <br /> (Ed. 7-01) <br /> C 1987 National Council on Compensation Insurance,Inc. <br />