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TRAVELERS` WORKERS COMPENSATION <br /> AND <br /> ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br /> HARTFORD CT 06183 <br /> ENDORSEMENT WC 00 00 01 (A) <br /> POLICY NUMBER: UB-3T085335-24-14-G <br /> LISTING OF ENDORSEMENTS <br /> EXTENSION OF INFO PAGE <br /> We agree that the following listed endorsements form a part of this policy on its effective date. <br /> WC 28 04 05 00 - 001 NH AUDIT NONCOMPLIANCE CHARGE ENDT <br /> WC 32 03 01 D - 001 NORTH CAROLINA AMENDED COVERAGE ENDT <br /> WC 99 01 01 00 - 001 STATE WC COMP LAWS AND USL & H WC ACT <br /> WC 99 03 76 A - 001 WAIVER OF OUR RIGHTS TO RECOVER-CA <br /> WC 99 03 76 A - 002 WAIVER OF OUR RIGHTS TO RECOVER-CA <br /> WC 99 03 97 00 - 001 WYOMING AMENDATORY ENDORSEMENT <br /> WC 99 03 99 00 - 001 CA WORKERS' COMP NOTICE OF NON-RENEWAL <br /> WC 99 03 Al 00 - 001 NOTICE OF CANCELATION <br /> WC 99 03 C3 00 - 001 SPECIAL PROVISIONS ENDT <br /> WC 99 03 D3 A - 001 OHIO EMPLOYERS LIAB COVERAGE ENDT <br /> WC 99 03 F3 00 - 001 CA LIMITS OF LIABILITY ENDT <br /> WC 99 04 28 00 - 001 PREMIUM MANUALS AND DUE DATE ENDORSEMENT <br /> WC 99 06 10 B - 001 AMENDED CANCELLATION CONDITION ENDT <br /> WC 99 06 36 B - 001 CANCELLATION AMENDMENT - WASHINGTON <br /> WC 99 06 P6 00 - 001 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 002 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 003 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 004 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 005 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 006 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 007 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P6 00 - 008 FL NOTICE OF CANC OR NONRENEW DESIGN PER <br /> WC 99 06 P7 00 - 001 NOTICE OF CANC OR NONRENEW BY US ENDT <br /> WC 99 06 P8 00 - 001 FL NOTICE OF CANC OR NONRENEW BY US ENDT <br /> WC 99 06 Ql 00 - 001 EARLIER NOTICE OF CAN OR NONRE BY US END <br /> WC 99 06 R3 00 - 001 NOTICE OF CAN TO DESIGN PERSONS OR ORGAN <br /> WC 99 06 R3 00 - 003 NOTICE OF CAN TO DESIGN PERSONS OR ORGAN <br /> WC 99 06 R3 00 - 004 NOTICE OF CAN TO DESIGN PERSONS OR ORGAN <br /> WC 99 06 R4 00 - 001 NOT OF CAN OR NONREN DESIGN PERS OR ORG <br /> WC 99 06 R4 00 - 002 NOT OF CAN OR NONREN DESIGN PERS OR ORG <br /> WC 99 06 R4 00 - 003 NOT OF CAN OR NONREN DESIGN PERS OR ORG <br /> WC 99 06 R4 00 - 004 NOT OF CAN OR NONREN DESIGN PERS OR ORG <br /> WC 99 06 R4 00 - 005 NOT OF CAN OR NONREN DESIGN PERS OR ORG <br /> DATE OF ISSUE: 05-28-24 ST ASSIGN: Pn^n 7 ^f '7 <br /> APPROVED <br /> By Cynthia Mora at 8:13 am,Oct 31,2024 <br />