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Pont <br />INDIANA FARM <br />BUREAU INSURANCE® <br />Worker's Compensation and Employer's Liability <br />Insurance Policy <br />Policy No' <br />WC 8341646 00 <br />Policy Period <br />From 08/21/2022 to 08/21/2023 at 12:01 a.m. Standard Time at the described location <br />ENDORSEMENT SCHEDULE <br />State <br />Number <br />Ed_ Date <br />Description <br />13 <br />WC000000C <br />01/15 <br />WORKERS COMP/EMPLOYER'S L,IAB <br />13 <br />WC000414A <br />01/19 <br />NOTIFICATION OF CHG IN OWNER <br />13 <br />WC000421F <br />01/22 <br />CATASTROPHE (OTHER THAN CERTF) <br />13 <br />WC000422C <br />01/21 <br />TERRORISM RISK PROGRAM REAUTH <br />13 <br />06-825 <br />12/88 <br />MUTUAL CONDITIONS <br />13 <br />21-201WC <br />04/05 <br />NOTICE TO POLICYHOLDERS <br />Issued Date: 08/23/202- <br />wcPFS 0494 INSURED Page 3 0= <br />