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SECTION III <br />1. SCHEDULE OF COVERED STATES <br />A. This endorsement only applies in the states <br />listed in this Schedule of Covered States. <br />C. Schedule of Covered States: <br />Countersigned by <br />B. If a state, shown in Item 3.A. of the <br />Information Page, approves this <br />endorsement after the effective date of this <br />policy, this endorsement will apply to this <br />policy. The coverage will apply in the new <br />state on the effective date of the state <br />approval. <br />Authorized Representative <br />Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 6 of 6 <br />REVIEWED BY: EUNICE HEREDIA (P o } <br />