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InformationPage,coveragewillnotbeaffordedforB.Notice <br />that state unless we are notified within thirty days. <br />Tellusatonceifyoubeginworkinanystatelistedin <br />Item 3.C. of the Information Page. <br />PART FOUR - YOUR DUTIES IF INJURY OCCURS <br />Tellusatonceifinjuryoccursthatmaybecoveredby4.Cooperatewithusandassistus,aswemay <br />this policy.Your other duties are listed here.request,intheinvestigation,settlementor <br />defense of any claim, proceeding or suit. <br />1.Provideforimmediatemedicalandotherservices <br />required by the workers compensation law.5.Donothingafteraninjuryoccursthatwould <br />interfere with our right to recover from others. <br />2.Giveusorouragentthenamesandaddressesof <br />theinjuredpersonsandofwitnesses,andother6.Donotvoluntarilymakepayments,assume <br />information we may need.obligationsorincurexpenses,exceptatyourown <br />cost. <br />3.Promptlygiveusallnotices,demandsandlegal <br />papersrelatedtotheinjury,claim,proceedingor <br />suit. <br />PART FIVE - PREMIUM <br />A.Our Manuals2.allotherpersonsengagedinworkthatcould <br />makeusliableunderPartOne(Workers <br />Allpremiumforthispolicywillbedeterminedbyour <br />CompensationInsurance)ofthispolicy.Ifyoudo <br />manualsofrules,rates,ratingplansand <br />nothavepayrollrecordsforthesepersons,the <br />classifications.Wemaychangeourmanualsand <br />contractpricefortheirservicesandmaterials <br />applythechangestothispolicyifauthorizedbylawor <br />maybeusedasthepremiumbasis.This <br />a governmental agency regulating this insurance. <br />paragraph2willnotapplyifyougiveusproof <br />B.Classifications <br />thattheemployersofthesepersonslawfully <br />Item4oftheInformationPageshowstherateand <br />secured their workers compensation obligations. <br />premiumbasisforcertainbusinessorwork <br />D.Premium Payments <br />classifications.Theseclassificationswereassigned <br />Youwillpayallpremiumwhendue.Youwillpaythe <br />basedonanestimateoftheexposuresyouwould <br />premiumevenifpartorallofaworkers <br />haveduringthepolicyperiod.Ifyouractual <br />compensation law is not valid. <br />exposuresarenotproperlydescribedbythose <br />classifications,wewillassignproperclassifications,E.Final Premium <br />ratesandpremiumbasisbyendorsementtothis <br />ThepremiumshownontheInformationPage, <br />policy. <br />schedules,andendorsementsisanestimate.The <br />C.Remunerationfinalpremiumwillbedeterminedafterthispolicyends <br />byusingtheactual,nottheestimated,premiumbasis <br />Premiumforeachworkclassificationisdeterminedby <br />andtheproperclassificationsandratesthatlawfully <br />multiplyingaratetimesapremiumbasis. <br />applytothebusinessandworkcoveredbythis <br />Remuneration is the most common premium basis. <br />policy.Ifthefinalpremiumismorethanthepremium <br />Thispremiumbasisincludespayrollandallother <br />youpaidtous,youmustpayusthebalance.Ifitis <br />remunerationpaidorpayableduringthepolicyperiod <br />less,wewillrefundthebalancetoyou.Thefinal <br />for the services of: <br />premiumwillnotbelessthanthehighestminimum <br />1.Allyourofficersandemployeesengagedinwork <br />premium for the classifications covered by this policy. <br />covered by this policy; and <br />Form WC 00 00 00 CPrinted in U.S.A.Page5 of6 <br /> <br />