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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 01 D <br /> ( Ed . 02=18) <br /> It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance . <br /> No condition , provision , agreement, or understanding not set forth in this policy or such endorsements shall affect such contract <br /> or any rights , duties , or privileges arising therefrom . <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 12/11 /2021 Policy No . WWC3560056 Endorsement No . <br /> Insured Tank-Tight Systems Inc Insurance Company Wesco Insurance Company <br /> Countersigned by <br /> i <br /> 2 of 2 <br /> i <br />