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Information Page, coverage will not be afforded for B. Notice <br />that state unless we are notified within thirty days. Tell us at once if you begin work in any state listed in <br />Item 3.C. of the Information Page. <br />PART FOUR - YOUR DUTIES IF INJURY OCCURS <br />Tell us at once if injury occurs that may be covered by <br />this policy. Your other duties are listed here. <br />1. Provide for immediate medical and other services <br />required by the workers compensation law. <br />2. Give us or our agent the names and addresses of <br />the injured persons and of witnesses, and other <br />information we may need. <br />3. Promptly give us all <br />papers related to the <br />suit. <br />A. Our Manuals <br />notices, demands and legal <br />injury, claim, proceeding or <br />4. Cooperate with us and assist us, as we may <br />request, in the investigation, settlement or <br />defense of any claim, proceeding or suit. <br />5. Do nothing after an injury occurs that would <br />interfere with our right to recover from others. <br />6. Do not voluntarily make payments, assume <br />obligations or incur expenses, except at your own <br />cost. <br />PART FIVE - PREMIUM <br />All premium for this policy will be determined by our <br />manuals of rules, rates, rating plans and <br />classifications. We may change our manuals and <br />apply the changes to this policy if authorized by law or <br />a governmental agency regulating this insurance. <br />B. Classifications <br />Item 4 of the Information Page shows the rate and <br />premium basis for certain business or work <br />classifications. These classifications were assigned <br />based on an estimate of the exposures you would <br />have during the policy period. If your actual <br />exposures are not properly described by those <br />classifications, we will assign proper classifications, <br />rates and premium basis by endorsement to this <br />policy. <br />C. Remuneration <br />Premium for each work classification is determined by <br />multiplying a rate times a premium basis. <br />Remuneration is the most common premium basis. <br />This premium basis includes payroll and all other <br />remuneration paid or payable during the policy period <br />for the services of: <br />1. All your officers and employees engaged in work <br />covered by this policy; and <br />Form WC 00 00 00 C Printed in U.S.A. <br />2. all other persons engaged in work that could <br />make us liable under Part One (Workers <br />Compensation Insurance) of this policy. If you do <br />not have payroll records for these persons, the <br />contract price for their services and materials <br />may be used as the premium basis. This <br />paragraph 2 will not apply if you give us proof <br />that the employers of these persons lawfully <br />secured their workers compensation obligations. <br />D. Premium Payments <br />You will pay all premium when due. You will pay the <br />premium even if part or all of a workers <br />compensation law is not valid. <br />E. Final Premium <br />The premium shown on the Information Page, <br />schedules, and endorsements is an estimate. The <br />final premium will be determined after this policy ends <br />by using the actual, not the estimated, premium basis <br />and the proper classifications and rates that lawfully <br />apply to the business and work covered by this <br />policy. If the final premium is more than the premium <br />you paid to us, you must pay us the balance. If it is <br />less, we will refund the balance to you. The final <br />premium will not be less than the highest minimum <br />premium for the classifications covered by this policy. <br />.9'�b yxsse P.�L"ry�V'�4 <br />y, 4 firma D]&APPROV®aY: <br />Il 1i a F'W-� z Vt 4a[ <br />®' Risk Management Analyst <br />