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POLICY NUMBER:76WEGAZ6AMU <br />NAME OF INSURER:Hartford Casualty Insurance Company <br />OurPresidentandSecretaryhavesignedthispolicy.Whererequiredbylaw,theInformationPagehasbeen <br />countersigned by our duly authorized representative. <br />Kevin Barnett, SecretaryM. Ross Fisher, President <br />Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. <br />©2000 National Council on Compensation Insurance, Inc. All Rights Reserved. <br />DELAWARE: <br />Delaware forms have been copyrighted by the Delaware Compensation Rating Bureau Inc. <br />NEW YORK: <br />Includes copyrighted material of the New York Compensation Insurance Rating Board, used with its permission. <br />© 2021 New York Compensation Insurance Rating Board, all rights reserved. <br />NORTH CAROLINA: <br />Includes copyrighted material of the North Carolina Rate Bureau, used with its permission. <br />PENNSYLVANIA: <br />Pennsylvania forms have been copyrighted by the Pennsylvania Compensation Rating Bureau. <br />Form WC 99 00 01 KPrinted in U.S.A.Page 1 of 1 <br />Process Date:08/17/24Policy Expiration Date:09/26/25 <br /> <br />