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PART FIVE - PREMIUM <br />A.Our Manuals is amended by adding this sentence: <br />In this part, "our manuals" means manuals approved or prescribed by the Texas Department of Insurance. <br />C.Remuneration <br />Number 2 is amended to read: <br />2.AllotherpersonsengagedinworkthatwouldmakeusliableunderPartOne(WorkersCompensationInsurance) <br />ofthispolicy.Thisparagraph2willnotapplyifyougiveusproofthattheemployersofthesepersonslawfully <br />secured workers compensation insurance. <br />D.Premium Payments is amended by adding this sentence: <br />The billing statement or invoice for audit additional premiums and/or retrospective additional premiums establishes the <br />date the premium is due. <br />E.Final Premium <br />Number 2 is amended to read: <br />2.Ifyoucancel,finalpremiumwillbecalculatedproratabasedonthetimethispolicywasinforce.Finalpremium <br />will not be less than the pro rata share of the minimum premium. <br />PART SIX - CONDITIONS <br />A.Inspection is amended by adding this sentence: <br />Your failure to comply with the safety recommendations made as a result of an inspection may cause the policy to be <br />canceled by us. <br />C.Transfer of Your Rights and Duties is amended to read: <br />Yourrightsanddutiesunderthispolicymaynotbetransferredwithoutourwrittenconsent.Ifyoudie,coveragewill <br />beprovidedforyoursurvivingspouseoryourlegalrepresentative.Thisappliesonlywithrespecttotheiractinginthe <br />capacity as an employer and only for the workplaces listed in Items 1 and 4 on the Information Page. <br />D.Cancellation is amended to read: <br />1.Youmaycancelthispolicy.Youmustmailordeliveradvancenoticetousstatingwhenthecancellationistotake <br />effect. <br />2.Wemaycancelthispolicy.Wemayalsodeclinetorenewit.Wemustgiveyouwrittennoticeofcancellationor <br />nonrenewal.Thatnoticewillbesentcertifiedmailordeliveredtoyouinperson.Acopyofthewrittennoticewill <br />be sent to the Texas Department of Insurance-Division of Workers' Compensation. <br />3.Noticeofcancellationornonrenewalmustbesenttoyounotlaterthanthe30thdaybeforethedateonwhichthe <br />cancellationornonrenewalbecomeseffective,exceptthatwemaysendthenoticenotlaterthanthe10thday <br />beforethedateonwhichthecancellationornonrenewalbecomeseffectiveifwecancelordonotrenewbecause <br />of: <br />a.Fraud in obtaining coverage; <br />b.Misrepresentation of the amount of payroll for purposes of premium calculation; <br />c.Failure to pay a premium when payment was due; <br />d.Anincreaseinthehazardforwhichyouseekcoveragethatresultsfromanactionoromissionandthatwould <br />produceanincreaseintherate,includinganincreasebecauseoffailuretocomplywithreasonable <br />recommendationsforlosscontrolortocomplywithinareasonableperiodwithrecommendationsdesignedto <br />reduce a hazard that is under your control; <br />e.AdeterminationbytheCommissionerofInsurancethatthecontinuationofthepolicywouldplaceusin <br />violation of the law, or would be hazardous to the interests of subscribers, creditors, or the general public. <br />4.IfanotherinsurancecompanynotifiestheTexasDepartmentofInsurance-DivisionofWorkers'Compensationthat <br />itisinsuringyouasanemployer,suchnoticemustbeacancellationofthispolicyeffectivewhentheotherpolicy <br />starts. <br />Add the following to the policy: <br />PART SEVEN - OUR DUTY TO YOU FOR CLAIM NOTIFICATION <br />A.Claims Notification <br />Wearerequiredtonotifyyouofanyclaimthatisfiledagainstyourpolicy.Thereafterwemustnotifyyouofany <br />proposaltosettleaclaimor,onreceiptofawrittenrequestfromyou,ofanyadministrativeorjudicialproceeding <br />relatingtotheresolutionofaclaim,includingabenefitreviewconferenceconductedbytheTexasDepartmentof <br />Insurance-Division of Workers' Compensation.You may, in writing, elect to waive this notification requirement. <br />Wemust,onthewrittenrequestfromyou,provideyouwithalistofclaimschargedagainstyourpolicy,payments <br />madeandreservesestablishedoneachclaim,andastatementexplainingtheeffectofclaimsonyourpremiumrates. <br />Wemustfurnishtherequestedinformationtoyouinwritingnolaterthanthe30thdayafterthedatewereceiveyour <br />request.TheinformationisconsideredtobeprovidedonthedatetheinformationisreceivedbytheUnitedStates <br />Postal Service or is personally delivered. <br />Form WC 42 03 01 LPrinted in U.S.A.Page2 of3 <br /> <br />