Laserfiche WebLink
WC 00 04 22 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> (Ed. 01-2021) <br /> Limitation of Liability <br /> The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar <br /> year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured <br /> Losses that exceeds$100,000,000,000; and for aggregate Insured Losses up to$100,000,000,000,we will pay only a pro <br /> rata share of such Insured Losses as determined by the Secretary of the Treasury. <br /> Policyholder Disclosure Notice <br /> 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured <br /> Losses occurring in any calendar year exceed $200,000,000,the United States Government would pay 80% of our <br /> Insured Losses that exceed our Insurer Deductible. <br /> 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any <br /> portion of Insured Losses that exceed $100,000,000,000. <br /> 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in <br /> Item 4 of the Information Page or in the Schedule below. <br /> Schedule <br /> State Rate Premium <br /> CA $0.01 $8.00 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective Policy No. Endorsement No. <br /> Insured Premium <br /> Insurance Company Countersigned by <br /> WC 00 04 22 C <br /> (Ed. 01-2021) <br /> 2 of 2 <br /> ©Copyright 2020 National Council on Compensation Insurance,Inc.All Rights Reserved. <br />