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In the state of VA, the premium charge is 5% of the total manual premium, <br /> subject to a minimum premium of$250 per policy. <br /> In the state of Wl, the premium charge is 2% of the total manual premium, <br /> subject to a minimum premium of$50 per policy. <br /> Issued by LM insurance Corporation 27243 <br /> For attachment to Policy No.WC5-Z51-290099-014 Effective Date 10/1/2024 <br /> Issued to Opex Corporation <br /> c�., HrE R1�k Mm+pge+rie+it i)Evlalvtt <br /> REMEWEDr1&APPRovED 8Y., <br /> WC 00 03 13 ©1983 National Council on Compensation Insurance, Risk Management Spedalist <br /> Ed. 04/01/1984 <br /> 62 <br />