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ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Waiver of Subrogation WVSUB Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $251.00 Ref# Description Coverage Code Form No. Edition Date YBYI YBYI Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $979.00 Ref# Description Coverage Code Form No, Edition Date Increased employer's liability INEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $2.00 Ref# Description Coverage Code Form No. Edition Date Premium discount PHIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$273.00 Ref# Description Coverage Code Form No. Edition Date Second Injury Fund 2NDIN Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $213.00 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 7 eductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount 7Deductible Type Premium Ref# Description Coverage Code For No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium tO�ADTLCV APPROVED Copyright 2001,AMS Services,Inc. By Cynthia Mara at 5:30 pm, Dec 02, 2024