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EXTENDED OPTIONS <br />1. Employers' Liability Insurance <br />Item 3.B. of the Information Page is replaced by <br />the following: <br />B. Employers' Liability Insurance: <br />1. Part Two of the policy applies to work in <br />each state listed in Item 3.A. <br />The Limits of Liability under Part Two are <br />the higher of: <br />Bodily Injury <br />by Accident $500,000 Each Accident <br />Bodily Injury <br />by Disease $500,000 Policy Limit <br />Bodily Injury <br />by Disease $500,000 Each Employee <br />OR <br />2. The amount shown in the Information <br />Page. <br />This provision 1 of EXTENDED OPTIONS does not <br />apply in New York because the Limits Of Our <br />Liability are unlimited. <br />In this provision the limits are changed from <br />$500,000 to $1,000,000 in California. <br />2. Unintentional Failure to Disclose Hazards <br />If you unintentionally should fail to disclose all <br />existing hazards at the inception date of your <br />policy, we shall not deny coverage under this <br />policy because of such failure. <br />3. Waiver of Our MgM To Reoover From Others <br />A. We have the right to recover our payments <br />from anyone liable for an injury covered by this <br />policy. We will not enforce our right against <br />any person or organization for whom you <br />perform work under a written contract that <br />requires you to obtain this agreement from us. <br />This agreement shall not operate directly or <br />indirectly to benefit anyone not named in the <br />agreement. <br />B. This provision 3. does not apply in the states <br />of Pennsylvania and Utah. <br />Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) <br />4. Foreign Voluntary Compensation and <br />Employers' Liability Reimbursement <br />A. How This Reimbursement Applies <br />This reimbursement provision applies to bodily <br />injury by accident or bodily injury by disease. <br />Bodily injury includes resulting death. <br />1. The bodily injury must be sustained by an <br />officer or employee. <br />2. The bodily injury must occur in the course <br />of employment necessary or incidental to <br />work in a country not listed in Exclusion <br />C.1. of this provision. <br />3. Bodily injury by accident must occur <br />during the policy period. <br />4. Bodily injury by disease must be caused <br />or aggravated by the conditions of your <br />employment. The officer or employee's <br />last exposure to those conditions of your <br />employment must occur during the policy <br />period. <br />B. We Will Reimburse <br />We will reimburse you for all amounts paid by <br />you whether such amounts are: <br />1. voluntary payments for the benefits that <br />would be required of you if you and your <br />officers or employees were subject to any <br />workers' compensation law of the state of <br />hire of the individual employee. <br />2. sums to which Part Two (Employers' <br />Liability Insurance) would apply if the <br />Country of Employment were shown in <br />Item 3.A. of the Information Page. <br />C. Exclusions <br />This insurance does not cover: <br />1. any occurrences in the United States, <br />Canada, and any country or jurisdiction <br />which is the subject of trade or economic <br />sanctions imposed by the laws or <br />regulations of the United States of <br />America in effect as of the inception date <br />of this policy. <br />2. any obligation imposed by a workers' <br />compensation or occupational disease <br />law, or similar law. <br />3. bodily injury intentionally caused or <br />aggravated by you. <br />RideMo%"natEDWIm <br />t cREAEwm&pAPePIRovED8y., a� f �M1Y�f.E h. V�F%IVKM <br />® Ruk Management Analyst <br />