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SCHEDULE OF FORMS AND ENDORSEMENTS <br />NAMED INSURED: Western Orange County Self- Funded Workers' TERM: July 1, 2013 to July 1, 2014 <br />Compensation Agency <br />POLICY NUMBER: WCX 0055277 00 <br />ENDT. NO. <br />FORM NO, <br />TITLE <br />1 <br />00 GL0386 00 (01 08) <br />LOSSES REDEFINED TO INCLUDE ALLOCATED LOSS <br />ADJUSTMENT EXPENSES ENDORSEMENT <br />2 <br />00 GL0368 05 (01 08) <br />CALIFORNIA VOLUNTEER COVERAGE — EXCESS <br />VOLUNTARY COMPENSATION AND EMPLOYERS LIABILITY <br />COVERAGE ENDORSEMENT <br />3 <br />00 GL0253 00 (01 08) <br />TERRORISM RISK INSURANCE PROGRAM <br />REAUTHORIZATION ACT ENDORSEMENT <br />4 <br />00 GL0403 05 01 08 <br />CALIFORNIA AMENDATORY ENDORSEMENT <br />00 GL0401 00 (01 08) <br />SPECIFIC EXCESS WORKERS COMPENSATION AND <br />EMPLOYERS LIABILITY INSURANCE POLICY <br />00 ML0012 00 01 03 Page 1 of 1 <br />