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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$250 per policy. <br /> Issued by LM Insurance Corporation 27243 <br /> For attachment to Policy No.WC5-Z11-C3H77D-013 Effective Date Premium$ <br /> Issued to Guidehouse Holding Corporation Endorsr -' / <br /> rt..,o e <br /> c <br /> (( Risk Management Divisl°n <br /> REVIEWED&APPROVED BY: <br /> i? p Q4 "Oa <br /> r <br /> WC 00 03 13 ©1983 National Council on Compensation Insurance. = -- Risk Management Specialist <br /> Ed.04/01/1984 / <br />