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EXTENDED OPTIONS <br />1.Employers’ Liability Insurance4.ForeignVoluntaryCompensationandEmployers’ <br />Liability Reimbursement <br />Item3.B.oftheInformationPageisreplacedby <br />the following:A.How This Reimbursement Applies <br />B.Employers’ Liability Insurance:Thisreimbursementprovisionappliestobodily <br />injurybyaccidentorbodilyinjurybydisease. <br />1.PartTwoofthepolicyappliestoworkin <br />Bodily injury includes resulting death. <br />each state listed in Item 3.A. <br />1.Thebodilyinjurymustbesustainedbyan <br />officer or employee. <br />TheLimitsofLiabilityunderPartTwoare <br />the higher of:2.Thebodilyinjurymustoccurinthecourseof <br />employmentnecessaryorincidentaltowork <br />inacountrynotlistedinExclusionC.1.ofthis <br />Bodily Injury <br />provision. <br />by Accident$500,000Each Accident <br />3.Bodilyinjurybyaccidentmustoccurduring <br />the policy period. <br />Bodily Injury <br />by Disease$500,000Policy Limit <br />4.Bodilyinjurybydiseasemustbecausedor <br />aggravatedbytheconditionsofyour <br />Bodily Injury <br />employment.Theofficeroremployee’slast <br />by Disease$500,000Each Employee <br />exposuretothoseconditionsofyour <br />employmentmustoccurduringthepolicy <br />OR <br />period. <br />B.We Will Reimburse <br />2.TheamountshownintheInformation <br />Wewillreimburseyouforallamountspaidby <br />Page. <br />you whether such amounts are: <br />Thisprovision1ofEXTENDEDOPTIONSdoes <br />1.voluntarypaymentsforthebenefitsthat <br />notapplyinNewYorkbecausetheLimitsOfOur <br />wouldberequiredofyouifyouandyour <br />Liability are unlimited. <br />officersoremployeesweresubjecttoany <br />Inthisprovisionthelimitsarechangedfrom <br />workers’compensationlawofthestateof <br />$500,000 to$1,000,000 in California. <br />hire of the individual employee. <br />2.Unintentional Failure to Disclose Hazards <br />2.sumstowhichPartTwo(Employers’Liability <br />Insurance)wouldapplyiftheCountryof <br />Ifyouunintentionallyshouldfailtodiscloseall <br />EmploymentwereshowninItem3.A.ofthe <br />existinghazardsattheinceptiondateofyour <br />Information Page. <br />policy,weshallnotdenycoverageunderthis <br />policy because of such failure. <br />C.Exclusions <br />3.Waiver of Our Right To Recover From Others <br />This insurance does not cover: <br />A.Wehavetherighttorecoverourpayments <br />1.anyoccurrencesintheUnitedStates, <br />fromanyoneliableforaninjurycoveredby <br />Canada,andanycountryorjurisdiction <br />thispolicy.Wewillnotenforceourright <br />whichisthesubjectoftradeoreconomic <br />againstanypersonororganizationforwhom <br />sanctionsimposedbythelawsorregulations <br />youperformworkunderawrittencontract <br />oftheUnitedStatesofAmericaineffectasof <br />thatrequiresyoutoobtainthisagreement <br />the inception date of this policy. <br />from us. <br />2.anyobligationimposedbyaworkers’ <br />Thisagreementshallnotoperatedirectlyor <br />compensationoroccupationaldiseaselaw, <br />indirectlytobenefitanyonenotnamedinthe <br />or similar law. <br />agreement. <br />3.bodilyinjuryintentionallycausedor <br />B.Thisprovision3.doesnotapplyinthestates <br />aggravated by you/ <br />of Pennsylvania and Utah. <br />Form WC 99 03 03 BPrinted in U.S.A. (Ed. 8/00)Page4 of6 <br /> <br />