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In the states of NY, OK and TN, the premium charge is 2%of the total <br /> manual premium, subject to a minimum premium of$250 per policy. <br /> 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 WI, the premium charge is 2%of the total manual premium <br /> plus the EL Increased Limits, subject to a minimum premium of$50 per <br /> policy. <br /> In the state of HI, the premium charge is $250 and determined as follows: <br /> The premium charge for this endorsement is 1% of the total manual premium, <br /> subject to a minimum premium of$250 per policy. <br /> Issued by LM Insurance Corporation 27243 <br /> For attachment to Policy No.WC5-Z11-C3H77D-014 Effective Date Premium$ <br /> Issued to Guidehouse Holding Corporation Endorsement No. <br /> WC 00 03 13 O 1983 National Council on Compensation Insurance. Page 2 of 2 <br /> Ed. 04101/1984 <br />