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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 10 <br />(Ed. 1-95) <br />DUTY TO DEFEND-CALIFORNIA <br />The insurance afforded by Part One, Section C, "We Will Defend", is hereby deleted and replaced with the following: <br />WE WILL DEFEND <br />We have the right and duty to defend at our expense any claim or proceeding against you before the California <br />Workers' Compensation Appeals Board or its equivalent in any other state (and any appeal of a decision therefrom) for <br />the benefits payable by this workers' compensation insurance. We have the right to investigate and settle these claims <br />or proceedings. <br />We have no duty to defend a claim, proceeding, or suit that is not covered by this insurance. <br />Nothing contained in this Section shall amend, modify, restrict or otherwise alter any obligations or conditions under <br />Part Two -Employer's Liability Insurance of the policy. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 09-07-21 Policy No. WC 80946 00 <br />Insured BACKHAUS DANCE <br />Insurance Company Sirius America Ins Co <br />Countersigned By <br />Endorsement No. <br />Premium $ Incl . <br />WC 04 03 10 <br />(Ed. 1-95) <br />Copyright 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rightsreserved. <br />From the WCIRB's California Workers' Compensation Insurance Forms Manual Copyright 194 <br />�oRaN <br />r� -:. ^ecoG< <br />4r <br />q� <br />Risk ManagemedDiviaian <br />cREVIEWED & APPROVED BY.- <br />rRd�-cG " PZ. v� <br />Risk Management Analyst <br />