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EXTENDED OPTIONS <br />1. Employers' Liability Insurance <br />Item 3.13. of the Information Page is replaced by the <br />following: <br />B. Employers' Liability Insurance: <br />1. Part Two of the policy applies to work in <br />each state listed in Item 3.A. <br />The Limits of Liability under Part Two are the <br />higher of: <br />Bodily Injury <br />by Accident $500,000 Each Accident <br />Bodily Injury <br />by Disease $500,000 Policy Limit <br />Bodily Injury <br />by Disease $500,000 Each Employee <br />OR <br />2. The amount shown in the Information Page. <br />This provision 1 of EXTENDED OPTIONS does not <br />apply in New York because the Limits Of Our Liability <br />are unlimited. <br />In this provision the limits are changed from $500,000 <br />to $1,000,000 in California. <br />2. Unintentional Failure to Disclose Hazards <br />If you unintentionally should fail to disclose all <br />existing hazards at the inception date of your policy, <br />we shall not deny coverage under this policy because <br />of such failure. <br />3. Waiver of Our Right To Recover From Others <br />A. We have the right to recover our payments from <br />anyone liable for an injury covered by this policy. <br />We will not enforce our right against any person <br />or organization for whom you perform work under <br />a written contract that requires you to obtain this <br />agreement from us. <br />This agreement shall not operate directly or <br />indirectly to benefit anyone not named in the <br />agreement. <br />B. This provision 3. does not apply in the states of <br />Pennsylvania and Utah. <br />Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) <br />4. Foreign Voluntary Compensation and <br />Employers' Liability Reimbursement <br />A. How This Reimbursement Applies <br />This reimbursement provision applies to bodily <br />injury by accident or bodily injury by disease. <br />Bodily injury includes resulting death. <br />1. The bodily injury must be sustained by an <br />officer or employee. <br />2. The bodily injury must occur in the course of <br />employment necessary or incidental to work <br />in a country not listed in Exclusion C.1. of <br />this provision. <br />3. Bodily injury by accident must occur during <br />the policy period. <br />4. Bodily injury by disease must be caused or <br />aggravated by the conditions of your <br />employment. The officer or employee's last <br />exposure to those conditions of your <br />employment must occur during the policy <br />period. <br />B. We Will Reimburse <br />We will reimburse you for all amounts paid by <br />you whether such amounts are: <br />1. voluntary payments for the benefits that <br />would be required of you if you and your <br />officers or employees were subject to any <br />workers' compensation law of the state of <br />hire of the individual employee. <br />2. sums to which Part Two (Employers' <br />Liability Insurance) would apply if the <br />Country of Employment were shown in Item <br />3.A. of the Information Page. <br />C. Exclusions <br />This insurance does not cover: <br />1. any occurrences in the United States, <br />Canada, and any country or jurisdiction <br />which is the subject of trade or economic <br />sanctions imposed by the laws or <br />regulations of the United States of America <br />in effect as of the inception date of this <br />policy. <br />2. any obligation imposed by a workers' <br />compensation or occupational disease law, <br />or similar law. <br />3. bodily injury intentionally caused or <br />aggravated by you. <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />--� Risk janagement Analyst <br />