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Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 6 of 6 <br />SECTION III <br />1.SCHEDULE OF COVERED STATES <br />A.This endorsement only applies in the states <br />listed in this Schedule of Covered States. <br />B.If a state,shown in Item 3.A.of the Information <br />Page,approves this endorsement after the <br />effective date of this policy,this endorsement will <br />apply to this policy.The coverage will apply in <br />the new state on the effective date of the state <br />approval <br />C.Schedule of Covered States: <br />CA <br />Countersigned by <br />Authorized Representative <br />DocuSign Envelope ID: 27E79A54-51B9-4F19-98C5-1BA1910A416BDocusign Envelope ID: DCCE584E-8537-4AA6-B403-1E9A11096495