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SUPPLEMENT TO CERTIFICATE OF INSURANCE
<br />DATE
<br />NAME OF INSURED:
<br />Additional Description of Operations /Remarks from Page 1:
<br />Additional Information,
<br />The Workers' Compensation coverage shown does not apply in monopolistic states.
<br />In the States of ND, OM, WA and WY Workers' Compensation coverage is provided by the State Fund.
<br />In those States, the below - referenced policies provide Stop -Gap Employers, Liability only.
<br />Workers Compensation policies apply as indicated below:
<br />National Anion Fire Ins Cc Pittsburgh, PA (NAIC# 19445100):
<br />WC 035896656 - CA
<br />Insurance Company Of The State Of PA (NATC# 19429100):
<br />WC n5896661 - MA, WI (Stop Gap - NO, OM, WA, WY)
<br />WC 035896662 - AX, AL, AR, A2, CO, DE, GA, ID, XS, XY, MD., ME; MO., MS, MT, NC., NH, NM, NV, OX, OR,
<br />PA, RI, SC, SD, TN, AT, VA, VT, WV
<br />WC 035896658 - MN
<br />WC 035896659 - NY
<br />Illinois National Ins Co (NAIC# 23817001)e
<br />WC 035896657 - FL
<br />WC. 035896663 - CT, DC, HI, IA, IL, IN, LA, MI, NE, NJ
<br />WC 035896660 - TX
<br />SUPP (05104)
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