Endorsements « Back to Forms The following Endorsements are acceptable or available in the State of Wisconsin WC 00 01 01 A Defense Base Act Coverage Endorsement WC 00 01 02 B Federal Mine Safety and Health Act Coverage Endorsement WC 00 01 04 A Federal Employers' Liability Act Coverage Endorsement WC 00 01 06 A Longshore and Harbor Workers' Compensation Act Coverage Endorsement WC 00 01 08 A Nonappropriated Fund Instrumentalities Act Coverage Endorsement WC 00 01 09 C Outer Continental Shelf Lands Act Coverage Endorsement WC 00 01 15 TRIA Notification Endorsement WC 00 02 01 B Maritime Coverage Endorsement WC 00 02 03 Voluntary Compensation Maritime Coverage Endorsement WC 00 03 01 A Alternate Employer Endorsement WC 00 03 02 Designated Workplaces Exclusion Endorsement WC 00 03 03 C Employers Liability Coverage Endorsement WC 00 03 04 Insurance Company as Insured Endorsement WC 00 03 05 Joint Venture as Insured Endorsement WC 00 03 08 Partners, Officers, and Others Exclusion Endorsement WC 00 03 09 B Rural Utilities Service Endorsement WC 00 03 10 Sole Proprietors, Partners, Officers, and Others Coverage Endorsement WC 00 03 11 A Voluntary Compensation and Employers Liability Coverage Endorsement WC 00 03 13 Waiver of Our Right to Recover From Others Endorsement WC 00 04 03 Experience Rating Modification Factor Endorsement WC 00 04 04 Pending Rate Change Endorsement WC 00 04 05 Policy Period Endorsement WC 00 04 06 A Premium Discount Endorsement WC 00 04 07 Rate Change Endorsement WC 00 04 08 Longshore and Harbor Workers' Compensation Act Rate Change Endorsement WC 00 04 12 Contingent Experience Rating Modification Factor Endorsement WC 00 04 14 A Notification of a Change in Ownership Endorsement WC 00 04 19 Premium Due Date Endorsement WC 00 04 21 F Catastrophe (Other than Certified Acts of Terrorism) Premium Endorsement WC 00 04 22 C Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement WC 00 04 24 Audit Noncompliance Charge Endorsement WC 00 04 25 Experience Rating Modification Factor Revision Endorsement WC 00 05 03 D Retrospective Premium Endorsement—One Year Plan WC 00 05 04 D Retrospective Premium Endorsement—Three Year Plan WC 00 05 05 D Retrospective Rating Plan Premium Endorsement—Wrap-up Construction Project WC 00 05 08 Retrospective Premium Endorsement—Aviation Exclusion WC 00 05 09 A Retrospective Premium Endorsement—Changes WC 00 05 10 B Retrospective Premium Endorsement—Non-Ratable Catastrophe Element or Surcharge WC 00 05 11 Retrospective Premium Endorsement—Short Form WC 00 05 12 D Retrospective Premium Endorsement—One Year Plan—Multiple Lines WC 00 05 13 D Retrospective Premium Endorsement—Three Year Plan—Multiple Lines WC 00 05 14 D Retrospective Premium Endorsement—Long Term Construction Project—Multiple Lines WC 00 05 15 A Retrospective Premium Endorsement—Flexibility Options WC 48 03 01 C Wisconsin Limited Other States Insurance Endorsement WC 48 03 02 A Wisconsin Work-Study Coverage Endorsement WC 48 03 03 Insured's Name and Address Linking Endorsement WC 48 03 04 Wisconsin Real Estate Salespersons Endorsement WC 48 03 14 A Wisconsin Employee Leasing Company Endorsement—Master Policy WC 48 03 15 A Wisconsin Employee Leasing Company Endorsement—Multiple Coordinated Policy (MCP) WC 48 03 16 Wisconsin Employee Leasing Company Client Termination Endorsement—Master Policy WC 48 03 17 Wisconsin Employee Leasing Company Client Exclusion Endorsement WC 48 03 18 Wisconsin Employee Leasing Company Client Mailing Address Endorsement WC 48 03 19 Notice of Cancellation or Material Coverage Change to Designated Government Entity WC 48 03 20 Wisconsin Franchisor Franchisee Coverage WC 48 03 21 Wisconsin Franchisor Franchisee Agreement Termination WC 48 03 22 Wisconsin Employee Leasing Company Leased Employee Inclusion WC 48 03 23 Wisconsin Designated Named Insured Cancellation WC 48 04 01 Wisconsin Contractors Premium Adjustment Program (WCPAP) Endorsement WC 48 06 01 C Wisconsin Law Endorsement WC 48 06 02 Wisconsin Rural Electrification Cooperative Loaned Employee Endorsement WC 48 06 03 B Foreign Coverage Endorsement WC 48 06 04 Wisconsin Waiver of Sovereign Immunity Endorsement WC 48 06 05 Change of Insurance Carrier Name Endorsement WC 48 06 06 B Wisconsin Cancellation and Nonrenewal Endorsement WC 48 06 07 Assumption of Liability Endorsement WC 89 06 00 B Policy Information Page Endorsement Large Risk Alternative Rating Option (LRARO) Endorsements WC 48 05 01 WI LRARO WC 48 05 01 A WI LRARO Schedule of Variability WC 48 05 02 A WI LRARO WC 48 05 03 A WI LRARO WC 48 05 06 B WI LRARO WC 48 05 06 WI LRARO Schedule of Variability WC 48 05 07 B WI LRARO WC 48 05 08 B WI LRARO WC 48 05 10 B WI LRARO WC 48 05 12 WI LRARO WC 48 05 12 A WI LRARO Schedule of Variability WC 48 05 14 WI LRARO WC 48 05 17 B WI LRARO WC 48 05 19 D WI LRARO Paid Loss Endorsement WC 48 05 20 A WI LRARO WC 48 05 22 WI LRARO WC 48 05 23 WI LRARO WC 48 05 24 WI LRARO