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rHIS ENDORSEMENT IS HEREBY MADE A PART OF THIq!CY ISSUED TO: <br />INSURED'S NAME POLICY NUMBERNKEY ERV. DIV'*" PiODUCER <br />AME <br />K M>SCRIVNER INC IRB 957-8891- IKMSCRI.1751v 105, 10.8556 1 <br />PRODUCER *FRANK 8 HALL & CO OF CALIFORNIA WORKERS' COMPENSATION <br />5260 N PALM 0400 AND <br />FRESNO CA 93704EMPLOYERS' LIABILITY <br />ENDORSEMENT <br />Industrial Indemnity <br />a Crum and Forma organization <br />INSURED K M SCRIVNER INC <br />DBA SCRIVNERS <br />SCRIVNER ENVIRONMENTAL SERVICES <br />P 0 BOX 1075 <br />COALINGA,'CA 93210 <br />T IS AGREED THAT THE POLICY DECLARATIONS ARE HEREBY AMENDED AS INDICATED BELOW <br />POLICY PERIOD: <br />01/01/92 TO 03/31/92 <br />THE EXPERIENCE MODIFICATION SHOWN SHALL:BE APPLIED TO THE PREMIUM DEVELOPE1 <br />FOR THE STATE INDICATED AT MANUAL RATES*' - <br />STATE MODIFICATION EFFECTIVE DATE <br />CALIFORNIA - 72 01/01/92 <br />ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. <br />ENDORSEMENT NO.: COMPANY' INDUSTRIAL INDEMNITY CO. <br />EFFECTIVE DATE: 01/01/92 ISSUED' 02/06/92 COUNTERSIGNED BY' <br />1C213 (1177) INSURED'S COPY <br />