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DocuSign Envelope ID:91 F43AFA-8CB4-4861-887A-F304C7A6614B <br /> SECTION III <br /> 7. SCHEDULE OF COVERED STATES B. If a state, shown in Item 3.A. of the Information <br /> A. This endorsement only applies in the states Page, approves this endorsement after the <br /> listed in this Schedule of Covered States. effective date of this policy, this endorsement <br /> will apply to this policy. The coverage will <br /> apply in the new state on the effective date of <br /> the state approval. <br /> C. Schedule of Covered States: <br /> NC <br /> Countersigned by <br /> Authorized Representative <br /> Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) Page 4 of 4 <br />