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ADDITIONAL COVERAGE SCHEDULE <br />COVERAGE <br />LIMITS <br />Per Statute <br />POLICY TYPE: Workers Compensation and Employers' <br />$1,000,000 E.L. Each accident <br />Liability <br />$1,000,000 E.L. Disease — policy limit <br />CARRIER: Charter Oak Fire Insurance Company <br />$1,000,000 E.L. Disease — each employee <br />POLICY TERM: 04/01/2016 — 0410112017 <br />POLICY NUMBER: HROUB- 4E33925 -8 -16 <br />,�O[i'i� <br />v q <br />� Rc� <br />LISP �,G, yOPt�otney <br />t <br />Pss\sta� <br />�D ) �� <br />