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INDIANA FARM Worker's Compensation and Employer's Liability <br />Peso BUREAU INSURANCE@ Insurance policy <br />Policy Nn. <br />WC 8341646 02 <br />Policy Period <br />From 0 8 / 21 / 2 0 2 4 to 0 8 / 21 / 2 0 2 5 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 LIAB <br />13 <br />WC000414A <br />01/19 <br />NOTIFICATION OF CHG IN OWNER <br />13 <br />WC000621F <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: 06/13/2024 <br />WCPES E4 94 <br />INSURED 00121-00005 <br />Pane :� of 'I <br />