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2. premi::ns for i:onds to release attaciEnents and <br />for appeal ends in i:ond amoiEnts i--p to tip <br />amo:Ant paya:]e iEnder Lis ins:1-ancei❑ <br />3. litigation costs taEod against yo❑❑ <br />4. interest on a ❑dgment as re❑Eired ❑y law Entil we <br />offer t❑e amount d0a ceder t❑is insLiranceLiand <br />El e::penses we inc:1-. <br />E. Other Insurance <br />We will not pay more tFian o!-ir sere of Flanefits and <br />costs co::Ored y tEJs instance and ot:ler instance <br />or self-insFirance. S❑❑iiect to any limits of lia-- Jlity that <br />may apply, all sires will Da e:]Fial ❑ntil tip loss is <br />paid. If any instance or self-insi rance is e=8::8ted, <br />Lie shares of all remaining insFirance will Da e❑❑al <br />Entil ti❑e loss is paid. <br />F. Payments You Must Make <br />You are responsiiJe for any payments in eE(,ess of tip <br />Lienefits regElarly pro:1ded y tip wor::Ors <br />compensation law incli❑ding ti❑ose re❑❑fired —ecaF]se❑ <br />1. of yoFir serioC:8 and willfF] miscondEc-t❑ <br />2. yo❑ Lnowingly employ an employee in dolation of <br />law ❑ <br />3. yo❑ fail to comply wit❑ a malt❑ or safety law or <br />reg nation ::or <br />4. yo❑ discharge, coerce or oti-lerwise discriminate <br />against any employee in !Jolation of tip worii;rs <br />compensation law. <br />If we matt; any payments in e::(,ess of tip iDenefits <br />regJarly pro:Jded iy tie worEors compensation law <br />on yoii- i❑eiialf, yoi❑will reim❑ irse ::8 promptly. <br />G. Recovery From Others <br />We i❑aEo yoii- rig::ts, and tip rig::ts of persons entitled <br />to tip iDenefits of tiffs ins❑rance, to recoii;r oiir <br />payments from anyone liaise for tiDa iniiry. <br />Yo❑ will do e::Oryti❑ing necessary to protect Lose <br />rigs is for ❑s and to Delp E8 enforce t❑em. <br />H. Statutory Provisions <br />T❑ese statements apply wDere t❑ey are re❑Eired ❑y <br />law. <br />1. As iDetween an iniii ed worEor and ice, we F18::0 <br />notice oft❑e iniii ywi❑en yo❑:18[0 notice. <br />2. YoFir defailt or tip i�aniEr::ptcy or insol::Oncy of <br />yo❑or yos estate will not reliei-:0 i-:8 of oi-i- dries <br />finder tiffs insiiance after an iniEry occ:lrs. <br />3. We are directly and primarily liaiFle to any person <br />entitled to t!-10 iDenefits paya!Fle y t!As ins!-irance. <br />Ti❑ose persons may enforce o0r d-ties❑so may <br />an agency aiFt❑oriiEod y law. Enforcement may <br />Da against yo❑and Ds. <br />4. i=risdiction oEor yo❑ is Edrisdiction o::Or ::8 for <br />p0rposes of tip wori-:Ors compensation law. We <br />are iEoiEnd y decisions against yo❑ ❑nder tiDat <br />law, s❑i❑act to to pro:lsions of tiffs policy that <br />are not in conflict wit❑ ti at law. <br />El Ti❑is ins:1-ance conforms to tie parts of t❑e <br />wor::Ors compensation law tiFlat apply to:] <br />a. ❑enefits payade ❑y tEJs instance❑ <br />El special tacos, payments into seclirity or ot❑er <br />special finds, and assessments payaEle iy <br />❑; tinder tiat law. <br />6. Terms of tiffs inssance tit t conflict wit❑ Lie <br />worii;rs compensation law are changed ❑y tEJs <br />statement to conform to t❑at law. <br />❑ot::Jng in ti;se paragrapi❑; relie!i;s yo❑ of yoj dries <br />❑nder tJs policy. <br />PART TWO - EMPLOYERS LIABILITY INSURANCE <br />A. How This Insurance Applies <br />T❑is employers liaiJlity insurance applies to ::odily <br />iniii y iy accident or Eodily inii y y disease. Bodily <br />inEEEry inclides resifting deat❑. <br />1. T❑e ❑odily in❑7y mEM arise oE1 of and in t❑e <br />coii-se of t0a inEEEred employee® employment iy <br />yo h <br />2. T!❑e employment mi❑;t DO necessary or incidental <br />to yoir wor❑ in a state or territory listed in Item <br />3.A. of t❑ e Information Page. <br />3. Bodily inii y iy accident mist occii- during to <br />policy period. <br />4. Bodily in[Ei]-y uy disease m❑st ❑e ca❑sed or <br />aggravated uy t❑e conditions of yoa- <br />employment. T❑e employee® last day of last <br />Form WC 00 00 00 C Printed in ❑.S.A. Page 2 of 6 <br />