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Docusign Envelope ID: B576D624-E16E-4D9F-BC67-5703DE54A6F8 <br /> RAVELERS WORKERS COMPENSATION <br /> AND <br /> ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br /> HARTFORD CT 06183 <br /> ENDORSEMENT WC 00 00 01 (A ) <br /> POLICY NUMBER: UB-3R328606-24-I3-G <br /> LISTING OF ENDORSEMENTS <br /> EXTENSION OF INFO PAGE <br /> We agree that the following listed endorsements form a part of this policy on its effective date. <br /> WC 99 06 S1 00 - 008 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 S1 00 - 009 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 Si 00 - 009 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 S1 00 - 010 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 Si 00 - O11 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 S1 00 - 012 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 S1 00 - 013 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 S1 00 - 014 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 S1 00 - 015 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 Si 00 - 016 AK NOTICE OF CAN TO DESIGN PERSON OR ORG <br /> WC 99 06 T1 00 - 001 NY NOTICE CANCEL DESIGNATED GOV ENTITY <br /> WC 99 06 T1 00 - 005 NY NOTICE CANCEL DESIGNATED GOV ENTITY <br /> WC 99 06 T1 00 - 007 NY NOTICE CANCEL DESIGNATED GOV ENTITY <br /> WC 99 06 T1 00 - 008 NY NOTICE CANCEL DESIGNATED GOV ENTITY <br /> WC 99 06 T1 00 - 010 NY NOTICE CANCEL DESIGNATED GOV ENTITY <br /> WC 17 03 03 00 - 001 LOUISIANA DUTY TO DEFEND <br /> W24N1A14 - 001 IMPORTANT NOTICE SCHEDULE-RATING-MO <br /> DATE OF ISSUE: 10-18-24 ST ASSIGN: Page 6 of 6 <br />