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140 <br />� 0 <br />AMERISURE INSURANCE COMPANY NCC! Code No. 11525 <br />WORKERS' COMPENSATION AND EMPLOYERS* LIABILITY <br />GENERAL CHANGE ENDORSEMENT NO,1 <br />POLICY NUMBER <br />AGENCY NUMBER POLICY EFFECTIVE <br />I POLICY W(RATION <br />I ISSUE DATE <br />WC - 2013881 -06 <br />0815279 1i1It1112t�7 <br />'IOt{}1t2Ci <br />10l24t2007 <br />ACCOUNT NUMBER <br />AGENCY <br />10 191 <br />WACHOVIA INS SERVSIPALEIGH <br />INSURED <br />RESOLUTE BUILDING COMPANY. THE <br />PO SOX 3M <br />CHAPEL HILL, NC 27515 <br />The policy to,which this endorsement is attached is amended as shown below. <br />Effie: 141191407 <br />rT IS AGREED THAT GANCaLATION NOTIFICATION -ENDORSEMENT 8 IS AWED, <br />This endorsement rellects a net annual premium change of: so <br />Below is the policy summary as amended with this endorsement <br />SEE EXTE49iON OF INFORMATION PAQE 60.065 <br />EXPENSE C{3NUANT 250 <br />TOTAL. es nMATeD ANNUAL. PREMIUM 60,305 <br />P3{1 -2,632 <br />0 INSURED COPY <br />{`O.Mtorsio ed by 1 ✓ is <br />