Workers Compensation and Employers Liability Insurance Policy Information Page General Section Part One - Workers Compensation Insurance Part Two - Employers Liability Insurance Part Three - Other States Insurance Part Four - Your Duties if Injury Occurs Part Five - Premium Part Six - Conditions

Information Page 1 Describes insured 2 Shows coverage period 3 Summarizes coverages 4 Premium estimate Classification, estimated payroll, rate

General Section The Policy Who is Insured Workers Compensation Law State Locations

Part One - Workers Compensation A.How This Insurance Applies Bodily injury by accident must occur during the policy period Bodily injury by disease must be caused or aggravated by conditions of your employment. The employee’s last day of exposure to the conditions causing or aggravating such bodily injury must occur during the policy period. B. We Will Pay Benefits required by law C.We Will Defend D.We Will Also Pay Insured’s expenses Bonds and interest on judgments

Part One - continued F.Payments You Must Make Payments in excess of regular benefits required because: Serious or willful misconduct Hiring an employee in violation of law Failure to comply with safety regulations Discharge, coerce or discriminate against employee H.Statutory Provisions Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs.

Part 2 -Employer Liability Insurance Need for coverage Third-party-over suits Care and loss of services Consequential bodily injury Dual capacity Exclusions Outside the US or Canada Liability assumed under contract Punitive damages for illegally employed person Bodily injury intentionally caused by insured Damages from employment practices

WC and Employers’ Liability Policy Part 3 - Other States Insurance Part 4 - Duties If Injury Occurs Part 5 - Premium Recordkeeping requirements Adjusted premiums Part 6 - Conditions Inspection Assignment Cancellation