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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />QUICK REFERENCE <br />Beginning <br />on Page <br />INFORMATION PAGE <br />1 <br />General Section.............................................................. <br />1 <br />A. The Policy............................................................... <br />1 <br />B. Who Is Insured....................................................... <br />1 <br />C. Workers Compensation Law .................................. <br />1 <br />D. State....................................................................... <br />1 <br />E. Locations................................................................ <br />1 <br />Beginning <br />on Page <br />PART TWO - Continued <br />G. Limits of Liability .............................................. 4 <br />H. Recovery From Others ..................................... 4 <br />I. Actions Against Us ........................................... 4 <br />PART THREE - OTHER STATES INSURANCE 4 <br />A. How This Insurance Applies ............................. 4 <br />B. Notice............................................................... 5 <br />PART ONE- WORKERS COMPENSATION INSURANCE... 1 PART FOUR -YOUR DUTIES IF INJURY OCCURS..... 5 <br />A. <br />How This Insurance Applies ................................... <br />1 <br />B. <br />We Will Pay............................................................ <br />1 <br />PART <br />FIVE - PREMIUM............................................... 5 <br />C. <br />We Will Defend ....................................................... <br />1 <br />A. <br />Our Manuals..................................................... 5 <br />D. <br />We Will Also Pay .................................................... <br />1 <br />B. <br />Classifications.................................................. 5 <br />E. <br />Other Insurance...................................................... <br />2 <br />C. <br />Remuneration................................................... 5 <br />F. <br />Payments You Must Make ...................................... <br />2 <br />D. <br />Premium Payments.......................................... 5 <br />G. <br />Recovery From Others ........................................... <br />2 <br />E. <br />Final Premium.................................................. 5 <br />H. <br />Statutory Provisions ................................................ <br />2 <br />F. <br />Records............................................................ 6 <br />G. <br />Audit................................................................. 6 <br />PART <br />TWO - EMPLOYERS LIABILITY INSURANCE...... <br />2 <br />A. <br />How This Insurance Applies ................................... <br />2 <br />PART <br />SIX - CONDITIONS....................................... 6 <br />B. <br />We will Pay............................................................. <br />3 <br />A. <br />Inspection......................................................... 6 <br />C. <br />Exclusions.............................................................. <br />3 <br />B. <br />Long Term Policy............................................. 6 <br />D. <br />We Will Defend ....................................................... <br />3 <br />C. <br />Transfer of Your Rights and Duties.................. 6 <br />E. <br />We Will Also Pay .................................................... <br />4 <br />D. <br />Cancellation..................................................... 6 <br />F. <br />Other Insurance...................................................... <br />4 <br />E. <br />Sole Representative ......................................... 6 <br />IMPORTANT: This Quick Reference is not part of the Workers Compensation and Employers Liability Policy and does <br />not provide coverage. Refer to the Workers Compensation and Employers Liability Policy itself for <br />actual contractual provisions. <br />PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY. <br />Form WC 66 01 56 B Printed in U.S.A. <br />Process Date: 12/23/19 Polict <br />RWtnLvugarmieixwian <br />�LRenEwm&pMrRw®Br. <br />NOWN Rsk Management Analyst 3 <br />