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Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00)Page 2 of 6 <br />SECTION I <br />PARTS ONE and TWO <br />1.WE WILL ALSO PAY <br />D.We Will Also Pay of Part One (WORKERS’ <br />COMPENSATION INSURANCE); and <br />E.We Will Also Pay of Part Two <br />(EMPLOYERS’LIABILITY INSURANCE)is <br />replaced by the following: <br />We Will Also Pay <br />We will also pay these costs,in addition to <br />other amounts payable under this insurance, <br />as part of any claim,proceeding,or suit we <br />defend: <br />1.reasonable expenses incurred at our <br />request,INCLUDING loss of earnings; <br />2.premiums for bonds to release <br />attachments and for appeal bonds in <br />bond amounts up to the limit of our <br />liability under this insurance; <br />3.litigation costs taxed against you; <br />4.interest on a judgment as required by law <br />until we offer the amount due under this <br />law; and <br />5.expenses we incur. <br />PART THREE <br />2.How This Insurance Applies <br />Paragraph 4.of A.How This Insurance Applies of <br />Part 3 (Other States Insurance)is replaced by the <br />following: <br />4.If you have work on the effective date of this <br />policy in any state not listed in Item 3.A.of the <br />Information Page,coverage will not be afforded <br />for that state unless we are notified within sixty <br />days. <br />PART SIX <br />3.Transfer Of Your Rights and Duties <br />C.Transfer Of Your Rights and Duties of Part 6 <br />(Conditions) is replaced by the following: <br />Your rights or duties under this policy may not be <br />transferred without our written consent. <br />If you die and we receive notice within sixty days <br />after your death,we will cover your legal <br />representative as insured. <br />4.Liberalization <br />If we adopt a change in this form that would broaden <br />the coverage of this form without extra charge,the <br />broader coverage will apply to this policy.It will apply <br />when the change becomes effective in your state. <br />SECTION II <br />VOLUNTARY COMPENSATION ANDEMPLOYERS’ <br />LIABILITY COVERAGE <br />5.Voluntary Compensation Insurance <br />A.How This Insurance Applies <br />This insurance applies to bodily injury by <br />accident or bodily injury by disease.Bodily <br />injury includes resulting death. <br />1.The bodily injury must be sustained by <br />any officer or employee not subject to the <br />workers’compensation law of any state <br />shown in Item 3.A.of the Information <br />Page. <br />2.The bodily injury must arise out of and in <br />the course of employment or incidental to <br />work in a state shown in Item 3.A.of the <br />Information Page. <br />3.The bodily injury must occur in the United <br />States of America,its territories or <br />possessions,or Canada,and may occur <br />elsewhere if the employee is a United States <br />or Canadian citizen,or otherwise legal <br />resident,and legally employed,in the United <br />States or Canada and temporarily away from <br />those places. <br />4.Bodily injury by accident must occur during <br />the policy period. <br />5.Bodily injury by disease must be caused or <br />aggravated by the conditions of the <br />DocuSign Envelope ID: 27E79A54-51B9-4F19-98C5-1BA1910A416B