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SECTION I <br />PARTS ONE and TWO <br />PART THREE <br />1. WE WILL ALSO PAY 2. <br />How This Insurance Applies <br />D. We Will Also Pay of Part One (WORKERS' <br />Paragraph 4. of A. How This Insurance Applies of <br />COMPENSATION INSURANCE); and <br />Part 3 (Other States Insurance) is replaced by the <br />following: <br />E. We Will Also Pay of Part Two <br />(EMPLOYERS' LIABILITY INSURANCE) is <br />4. If you have work on the effective date of this <br />replaced by the following: <br />policy in any state not listed in Item 3.A. of the <br />Information Page, coverage will not be afforded <br />We Will Also Pay <br />for that state unless we are notified within sixty <br />We will also pay these costs, in addition to <br />days. <br />other amounts payable under this insurance, <br />as part of any claim, proceeding, or suit we <br />PART SIX <br />defend: 3. <br />Transfer Of Your Rights and Duties <br />1. reasonable expenses incurred at our <br />C. Transfer Of Your Rights and Duties of Part 6 <br />request, INCLUDING loss of earnings; <br />(Conditions) is replaced by the following: <br />2. premiums for bonds to release <br />Your rights or duties under this policy may not be <br />attachments and for appeal bonds in <br />transferred without our written consent. <br />bond amounts up to the limit of our <br />liability under this insurance; <br />If you die and we receive notice within sixty days <br />3. litigation costs taxed against you; <br />after your death, we will cover your legal <br />representative as insured. <br />4. interest on a judgment as required by law 4. <br />Liberalization <br />until we offer the amount due under this <br />law; and <br />If we adopt a change in this form that would broaden <br />the coverage of this form without extra charge, the <br />5. expenses we incur. <br />broader coverage will apply to this policy. It will apply <br />when the change becomes effective in your state. <br />SECTION II <br />VOLUNTARY COMPENSATION ANDEMPLOYERS' <br />3. The bodily injury must occur in the United <br />LIABILITY COVERAGE <br />States of America, its territories or <br />5. Voluntary Compensation Insurance <br />possessions, or Canada, and may occur <br />elsewhere if the employee is a United States <br />A. How This Insurance Applies <br />or Canadian citizen, or otherwise legal <br />This insurance applies to bodily injury by <br />resident, and legally employed, in the United <br />accident or bodily injury by disease. Bodily <br />States or Canada and temporarily away from <br />injury includes resulting death. <br />those places. <br />1. The bodily injury must be sustained by <br />4. Bodily injury by accident must occur during <br />any officer or employee not subject to the <br />the policy period. <br />workers' compensation law of any state <br />5. Bodily injury by disease must be caused or <br />shown in Item 3.A. of the Information <br />aggravated by the conditions of the <br />Page. <br />2. The bodily injury must arise out of and in <br />the course of employment or incidental to <br />work in a state shown in Item 3.A. of the <br />Information Page. <br />Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 2 of <br />l� <br />