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F1 <br />POLICY INSURER LIST BY JURISDICTION <br />INSURER NAIC JURISDICTION <br />Trumbull Insurance Company 27120 IN <br />ONE HARTFORD PLAZA <br />HARTFORD CT 06155 <br />Hartford Underwriters Insurance Company 30104 MO <br />ONE HARTFORD PLAZA <br />HARTFORD CT 06155 <br />Property and Casualty Insurance Company of Hartford 34690 CA <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: 06/10/21 Policy E) <br />i REVIEWED&APPRWM BY. <br />f4mlc� R. Uct6A <br />�� Risk Management Malyst <br />