Laserfiche WebLink
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WORKERS' COMPENSATION BROAD FORM ENDORSEMENT <br />Policy Number: 72 WEC AB1Z5Q Endorsement Number: <br />Effective Date: 02/01/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AEF Systems Consulting Inc <br />8502 E CHAPMAN AVE STE 376 <br />ORANGE CA 92869 <br />Section I of this endorsement expands coverage provided under WC 00 00 00. <br />Section II of this endorsement provides additional coverage usually only provided by endorsement. <br />Section III of this endorsement is a Schedule of Covered States. <br />You may use the index to locate these coverage features quickly: <br />INDEX <br />SUBJECT <br />SECTION I <br />PARTS ONE and TWO <br />01 We Will Also Pay <br />PART -THREE <br />02 How This Insurance Works <br />PART - SIX <br />03 Transfer of Your Rights and Duties <br />04 Liberalization <br />SECTION II <br />VOLUNTARY COMPENSATION INSURANCE <br />05 Voluntary Compensation Insurance <br />A. How This Insurance Applies <br />B. We will Pay <br />C. Exclusions <br />D. Before We Pay <br />E. Recovery From Others <br />F. Employers' Liability Insurance <br />EMPLOYERS' LIABILITY STOP GAP COVERAGE <br />06 Employers' Liability Stop Gap Coverage <br />A. Stop Gap Coverage Limited Montana, North Dakota, Ohio, Washington, West <br />Virginia and Wyoming <br />B. Part One does not Apply <br />C. Application of Coverage <br />D. Additional Exclusions <br />E. West Virginia <br />SECTION III <br />07 Schedule of Covered States <br />Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00) <br />Process Date: 12/23/19 Policy E: <br />© 2000, The Hartford <br />PAGE <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />2 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />3 <br />4 <br />4 <br />+I. 2 <br />RiskMaugmeni ElMatmt <br />Rt1 exm&AP Ravm8r <br />®' <br />Risk Management Analyst <br />