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EXTENDED OPTIONS <br /> 1. Employers' Liability Insurance 4. Foreign Voluntary Compensation and <br /> Item 3.13. of the Information Page is replaced by Employers' Liability Reimbursement <br /> the following: A. How This Reimbursement Applies <br /> B. Employers' Liability Insurance: This reimbursement provision applies to bodily <br /> 1. Part Two of the policy applies to work in injury by accident or bodily injury by disease. <br /> each state listed in Item 3.A. Bodily injury includes resulting death. <br /> 1. The bodily injury must be sustained by an <br /> The Limits of Liability under Part Two are officer or employee. <br /> the higher of: 2. The bodily injury must occur in the course <br /> of employment necessary or incidental to <br /> Bodily Injury work in a country not listed in Exclusion <br /> by Accident $500,000 Each Accident C.I. of this provision. <br /> 3. Bodily injury by accident must occur <br /> Bodily Injury during the policy period. <br /> by Disease $500,000 Policy Limit 4. Bodily injury by disease must be caused <br /> or aggravated by the conditions of your <br /> Bodily Injury employment. The officer or employee's <br /> by Disease $500,000 Each Employee last exposure to those conditions of your <br /> employment must occur during the policy <br /> OR period. <br /> B. We Will Reimburse <br /> 2. The amount shown in the Information We will reimburse you for all amounts paid by <br /> Page. you whether such amounts are: <br /> This provision 1 of EXTENDED OPTIONS does not 1. voluntary payments for the benefits that <br /> apply in New York because the Limits Of Our would be required of you if you and your <br /> Liability are unlimited. officers or employees were subject to any <br /> In this provision the limits are changed from workers' compensation law of the state of <br /> $500,000 to $1,000,000 in California. hire of the individual employee. <br /> 2. Unintentional Failure to Disclose Hazards 2. sums to which Part Two (Employers' <br /> If you unintentionally should fail to disclose all Liability Insurance) would apply if the <br /> existing hazards at the inception date of your Country of Employment were shown in <br /> policy, we shall not deny coverage under this <br /> Item 3.A. of the Information Page. <br /> policy because of such failure. C. Exclusions <br /> 3. Waiver of Our Right To Recover From Others This insurance does not cover: <br /> A. We have the right to recover our payments 1. any occurrences in the United States, <br /> from anyone liable for an injury covered by this Canada, and any country or jurisdiction <br /> policy. We will not enforce our right against which is the subject of trade or economic <br /> any person or organization for whom you sanctions imposed by the laws or <br /> perform work under a written contract that regulations of the United States of <br /> requires you to obtain this agreement from us. America in effect as of the inception date <br /> This agreement shall not operate directly or of this policy. <br /> indirectly to benefit anyone not named in the 2. any obligation imposed by a workers' <br /> agreement. compensation or occupational disease <br /> B. This provision 3. does not apply in the states law, or similar law. <br /> of Pennsylvania and Utah. 3. bodily injury intentionally caused or <br /> noorayntpd by you- <br /> APPROVED <br /> By Cynthia Mora at 11:34 am, Dec 05, 2024 <br /> Form WC 99 03 01 B Printed in U.S.A. (Ed. 8/00) Page 4 of 6 <br />