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DocuSign Envelope ID:26CB3394-9EF5-42C1-8EAB-432A9B415AA4 <br /> Statet°arm <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY <br /> INFORMATION PAGE ENDORSEMENT <br /> PAGE 02 <br /> 07-6379-F85D <br /> THIS FORMS A PART OF COVERAGE IS PROVIDED BY <br /> POLICY NO. 93-BX-U625-7 STATE FARM FIRE AND CASUALTY COMPANY <br /> 3 RAVINIA DRIVE , ATLANTA GA 30346-2117 <br /> NAMED INSURED AND MAILING ADDRESS RISK ID NO. 006219515 <br /> ANALYTICAL CONSULTANTS INC FEIN <br /> 125 KINGSTON DR STE 206 <br /> CHAPEL HILL NC 27514- 1649 <br /> THE EFFECTIVE DATE IS 10/01/2015 <br /> THE EXPIRATION DATE IS 10/01/2016 <br /> ITEM 38. OF THE POLICY , EMPLOYERS LIABILITY LIMITS <br /> ARE AMENDED AS FOLLOWS: <br /> BODILY INJURY BY ACCIDENT $ 500, 000 EACH ACCIDENT <br /> BODILY INJURY BY DISEASE $ 500, 000 EACH EMPLOYEE <br /> BODILY INJURY BY DISEASE $ 500, 000 POLICY LIMIT <br /> ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED . <br />