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Endorsement Endorsement Effective: Policy No.: Named Insured: Amendment to Schedule Item 11 Schedule Item 11 is amended to read as follows: 11. Classification of Operations: Total Manual Premium: (a) Experience Modification Factor: (b) Other Modification Factor: Normal Premium: Countersigned MIDWEST EMPLOYERS CASUALTY COMPANY Authorized Representative Secretary President This endorsement forms part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. All other terms and conditions of the Policy remain unchanged. CMB-11 (8-13) Page 1 of 1 Date Printed: Page 43 of 201