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POLICY INSURER LIST BY JURISDICTION <br />INSURER <br />NAIC <br />JURISDICTION <br />Sentinel Insurance Company Ltd. <br />11000 <br />CA <br />ONE HARTFORD PLAZA <br />HARTFORD CT 06155 <br />Trumbull Insurance Company <br />27120 <br />IL CO <br />ONE HARTFORD PLAZA <br />HARTFORD CT 06155 <br />Hartford Casualty Insurance Company <br />29424 <br />AZ WI <br />ONE HARTFORD PLAZA <br />HARTFORD CT 06155 <br />Hartford Underwriters Insurance Company <br />30104 <br />NC <br />ONE HARTFORD PLAZA <br />HARTFORD CT 06155 <br />THE COVERAGE PROVIDED IN EACH JURISDICTION IS WITH RESPECT TO THE LOCATIONS OF THE NAMED <br />INSURED IN THAT JURISDICTION IN ACCORDANCE WITH THE WORKERS' COMPENSATION LAW OF THAT <br />JURISDICTION. AS USED IN THIS POLICY, "COMPANY", "WE", "US" AND "OURS" MEAN THE MEMBER INSURANCE <br />COMPANIES OF THE HARTFORD INSURANCE GROUP COLLECTIVELY PROVIDING THIS INSURANCE. <br />Nothing herein, contained shall be held to vary, waive, alter or extend any of the terms, conditions, agreements or <br />information of the policy, other than as herein stated. <br />Form WC 66 04 40 Printed in U.S.A. <br />Process Date: 05/25/20 <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />Policy E _� RFskPjanagementAnalpt <br />