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CSAC EXCESS INSURANCE AUTHORITY EXCESS WORKERS' COMPENSATION MEMORANDUM OF COVERAGE FOR A QUALIFIED SELF-INSURED "COVERED PARTY" OF WORKERS' COMPENSATION AND EMPLOYERS LIABILITY CSAC Excess Insurance Authority (hereinafter Authority) agrees with the "Covered Party" named in the Declarations made a part hereof, in consideration of the payment of the premium and subject to all of the terms of this Memorandum, as follows: INSURING AGREEMENTS I. APPLICATION OF MEMORANDUM: This Memorandum applies to "loss" sustained by the "Covered Party" because of liability imposed upon the "Covered Party" by: A. The "Workers' Compensation Act" of each state named in Item 3 of the Declarations, or B. The "Workers' Compensation Act" of a state not named in Item 3 of the Declarations, provided that the state(s) named in Item 3 of the Declarations is the state(s) of the injured "employee's" normal employment or residence, or C. "Employers' Liability" on account of "Bodily Injury" or "occupational disease" sustained by "employees" of the "Covered Party", while engaged in operations of the "Covered Party", as a result of "occurrences" taking place during the coverage period and while this Memorandum is in force. The indemnity afforded by this Memorandum under Insuring Agreement I C for "loss" because of liability imposed by "Employers' Liability" applies only as respects such operations in the named states including, however, "employees" who are employed and are regularly engaged in such operations in the named states but who may be temporarily outside the named states in connection with such operations within the named states. As respects liability imposed by "Employers' Liability" the Authority shall have no obligation to indemnify the "Covered Party" for damages imposed in any lawsuit brought in, or any judgment rendered by, any court outside of the United States of America, its territories or possession, or Canada, or to any action on such judgment wherever brought. II. RETENTION AND INDEMNITY: As respects "loss" which the "Covered Party" sustains as a result of each "occurrence", the "Covered Party" shall retain "loss" in the amount of the "Covered Party's" Retention specified in Item 4 (a) of the Declarations and the Authority agrees to indemnify the "Covered Party" against "loss" in excess of such Retention. Notwithstanding the application of this Memorandum to "loss" sustained by the "Covered Party" under Subsections A, B and C of Agreement I, and regardless of the number of entities named in Item 1 of the Form 7/1/2004 Page 1 of 8 . ._--- .'---'-'"