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WORKERS COMPENSATION AND EMPLOYERS <br />LIABILITY INSURANCE POLICY <br />In ret:1n for tip payment of t-e premiiErn and si-❑iect to all terms of tits policy, we agree wit❑yo❑ as follows -I <br />GENERAL SECTION <br />A. The Policy <br />TEis policy incliEdes at its effecti::6 date tip <br />Information Page and all endorsements and sc:led:les <br />listed t0ere. It is a contract of ins0rance -etween yo❑ <br />Ft -le employer named in Item 1 of tip Information <br />Page❑and ::8 iYle insi-i-er named on tFle Information <br />Pageil Ti-e only agreements relating to tEls ins0rance <br />are stated in ti-Js policy. Ti-e terms of ti-Js policy may <br />not Fie changed or waiiEOd ei-(,ept Dy endorsement <br />issi ed :y ❑s to :]a part of tEJs policy. <br />B. Who Is Insured <br />Yo❑ are ins�Ted if yoDare an employer named in Item <br />1 of tie Information Page. If tEat employer is a <br />partnersi-- ip, and if yo❑ are one of its partners, yo❑ are <br />insi-Ted, Fi-t only in yo:l- capacity as an employer of <br />tip partnersi�pi-9 employees. <br />C. Workers Compensation Law <br />Wor-erS Compensation Law means t-e worEors or <br />wor-rnenS compensation law and occ-pational disease <br />law of eac❑ state or territory named in Item 3.A. of tip <br />Information Page. It incliEdes any amendments to <br />that law wuc-are in effect dimming tip policy period. It <br />does not inch -le any federal wori-:Ors or wor::nen:g <br />compensation law, any federal occgpational disease <br />law or tip pro:1sions of any law that proElde <br />nonocci-pational disa::Jlity iElenefits. <br />D. State <br />State means any state of t-e ❑nited States of <br />America, and tile District of ColEME]a. <br />E. Locations <br />TEis policy coi-ers all of yoi-i- woriEplaces listed in <br />Items 1 or 4 of tie Information Pagei-and it co -ors all <br />ot:ler wor!Eplaces in Item 3.A. states bless yo❑ :]8i-:0 <br />ot:ler ins-rance or are self-insiFi-ed for si:ci- <br />woriEplaces. <br />PART ONE - WORKERS COMPENSATION INSURANCE <br />A. How This Insurance Applies <br />TJs worEors compensation ins:lance applies to <br />Fodily inEry i:y accident or iFodily inufl-y -y disease. <br />Bodily in -may inclLdes resiElting deat❑. <br />1. Bodily iniEEry Dy accident mC:8t occEir d0ring t-� <br />policy period. <br />2. Bodily inlory Dy disease milt Fle cared or <br />aggrai:ated Ey tip conditions of yo:lr employment. <br />T❑e employees last day of last eEposL]re to t0e <br />conditions ca-5ing or aggra-sting s❑c❑ -odily <br />inmy Ey disease m-st ocCir doing t-e policy <br />period. <br />B. We Will Pay <br />We will pay promptly wiDen dim tip iDenefits re-i�red <br />of yo❑ Dy t-le wor[ors compensation law. <br />C. We Will Defend <br />We 08i-:0 tip rigi-t and dAy to defend at o0- eiEpense <br />any claim, proceeding or sut against yo❑for Jenefits <br />paya:Ae Ey ti-Js insFirance. We 08-e tDa rig Et to <br />inEostigate and settle tFlase claims, proceedings or <br />sits. <br />We 08E:0 no dirty to defend a claim, proceeding or <br />sit tilat is not coEOred Dy tiis insFirance. <br />D. We Will Also Pay <br />We will also pay tE ese costs, in addition to ot:ler <br />amoiAts payaie iAder tis insuance, as part of any <br />claim, proceeding or snit we defend❑ <br />1. reasonaie egcenses inured at o0r re-Eest, ❑A <br />not loss of earnings❑ <br />Form WC 00 00 00 C Printed in ❑.S.A. <br />Process Date: 11/04/2❑ <br />Page 1 of 6 <br />Policy Expiration Date: 11/04/26 <br />