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WC 00 04 22 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />(Ed, 1-15) <br />2. Notwithstanding Item 1 above, the United States Government will not make any payment under the Act for any <br />portion of Insured Losses that exceed $100,000,000,000, <br />3. The premium charge for the coverage your policy provides for Insured Losses Is included In the amount shown In <br />Item A of the Information Page or In the Schedule below. <br />State <br />Schedule <br />Rate <br />Premium <br />This endorsement changes the Polley to Which it Is attached and is effective on the date issued unless olhorwlso stated. <br />(The Information below is required only when this endorsement is Issued subsequent to preparation of the policy,) <br />Endorsement Effective Policy No. <br />Insured <br />insurance Company <br />WC0004228 <br />(Ed. 1-15) <br />Endorsement No. <br />Premium $ <br />Countorsigned By <br />0 Copyright 20t5 National Council on Compan9allon Insurance, Inc. All Rights Rosarvad, <br />REVIEWED & APPROVED <br />By RISK MANAGEMENT DIVISION <br />0 T 28 2019-- <br />FRANCINE R. VILLAREAL <br />