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SECTION I <br />PARTS ONE and TWOPART THREE <br />2.How This Insurance Applies <br />1.WE WILL ALSO PAY <br />Paragraph4.ofA.HowThisInsuranceAppliesof <br />D.WeWillAlsoPayofPartOne(WORKERS’ <br />Part3(OtherStatesInsurance)isreplacedbythe <br />COMPENSATION INSURANCE); and <br />following: <br />E.WeWillAlsoPayofPartTwo <br />4.Ifyouhaveworkontheeffectivedateofthis <br />(EMPLOYERS’LIABILITYINSURANCE)is <br />policyinanystatenotlistedinItem3.A.ofthe <br />replaced by the following: <br />InformationPage,coveragewillnotbeafforded <br />We Will Also Pay <br />forthatstateunlesswearenotifiedwithinsixty <br />Wewillalsopaythesecosts,inadditionto <br />days. <br />otheramountspayableunderthisinsurance, <br />aspartofanyclaim,proceeding,orsuitwe <br />PART SIX <br />defend: <br />3.Transfer Of Your Rights and Duties <br />1.reasonableexpensesincurredatour <br />C.TransferOfYourRightsandDutiesofPart6 <br />request,INCLUDING loss of earnings; <br />(Conditions) is replaced by the following: <br />2.premiumsforbondstorelease <br />Yourrightsordutiesunderthispolicymaynotbe <br />attachmentsandforappealbondsin <br />transferred without our written consent. <br />bondamountsuptothelimitofour <br />Ifyoudieandwereceivenoticewithinsixtydays <br />liability under this insurance; <br />afteryourdeath,wewillcoveryourlegal <br />3.litigation costs taxed against you; <br />representative as insured. <br />4.interestonajudgmentasrequiredbylaw <br />4.Liberalization <br />untilweoffertheamountdueunderthis <br />Ifweadoptachangeinthisformthatwouldbroaden <br />law; and <br />thecoverageofthisformwithoutextracharge,the <br />5.expenses we incur. <br />broadercoveragewillapplytothispolicy.Itwillapply <br />when the change becomes effective in your state. <br />SECTION II <br />VOLUNTARY COMPENSATION ANDEMPLOYERS’3.ThebodilyinjurymustoccurintheUnited <br />LIABILITY COVERAGEStatesofAmerica,itsterritoriesor <br />possessions,orCanada,andmayoccur <br />5.Voluntary Compensation Insurance <br />elsewhereiftheemployeeisaUnitedStates <br />A.How This Insurance Applies <br />orCanadiancitizen,orotherwiselegal <br />Thisinsuranceappliestobodilyinjuryby <br />resident,andlegallyemployed,intheUnited <br />accidentorbodilyinjurybydisease.Bodily <br />StatesorCanadaandtemporarilyawayfrom <br />injury includes resulting death. <br />those places. <br />1.Thebodilyinjurymustbesustainedby <br />4.Bodilyinjurybyaccidentmustoccurduring <br />anyofficeroremployeenotsubjecttothe <br />the policy period. <br />workers’compensationlawofanystate <br />5.Bodilyinjurybydiseasemustbecausedor <br />showninItem3.A.oftheInformation <br />aggravatedbytheconditionsofthe <br />Page. <br />2.Thebodilyinjurymustariseoutofandin <br />thecourseofemploymentorincidentalto <br />workinastateshowninItem3.A.ofthe <br />Information Page/ <br />Form WC 99 03 03 BPrinted in U.S.A. (Ed. 8/00)Page2 of6 <br /> <br />