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DocuSign Envelope ID:91 F43AFA-8CB4-4861-887A-F304C7A6614B <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> PREMIUM DUE DATE ENDORSEMENT <br /> Policy Number: 22 WEC CN3905 Endorsement Number: <br /> Effective Date: 10/01/15 Effective hour is the same as stated on the Information Page of the policy. <br /> Named Insured and Address: NORTH CAROLINA PUBLIC HEALTH <br /> FOUNDATION <br /> PO BOX 18763 <br /> RALEIGH, NC 27619 <br /> Section D of Part Five of the policy is replaced by this provision: <br /> PART FIVE <br /> PREMIUM <br /> D. Premium is amended to read: compensation law is not valid. The due date for <br /> You will pay all premium when due. You will pay audit and retrospective premiums is the date of <br /> the premium even if part or all of a workers the billing. <br /> Countersigned by <br /> Authorized Representative <br /> Form WC 00 04 19 Printed in U.S.A. <br /> Process Date: 08/01/15 Policy Expiration Date: 10/01/16 <br />