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6.E. - Page 19 of 27 <br />F� <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WORKERS' COMPENSATION BROAD FORM ENDORSEMENT <br />EXTENDED OPTIONS <br />Policy/ Number. 6ME0199 <br />Effeattve Dake: 4/30/2019 Effective hour Is the same as stated on the Information Page of the policy. <br />Named Insured and Address: <br />IPA, kn <br />8199 CWftmla Avenue, Suite 100 <br />Wne, CA 92617 <br />Section I of this endorsement expands coverage provided under WC 00 00 00. <br />SeWon II of this endorsement provides additional coverage Usually only provided by endorsement. <br />Section III of this endorsement is a Schedule of Covered States. <br />You may use the Index to locate these coverage features quickly. <br />INDEX <br />SUBJEI <br />EAM <br />SUBJECT <br />SAGE <br />SECTION 1 <br />2 <br />B. Part One Does Not Apply <br />3 <br />PARTS ONE and TWO <br />2 <br />C. Application of Coverage <br />3 <br />01 We Will Also Pay <br />2 <br />D. Additional Exciuslons <br />3 <br />PART -THREE <br />2 <br />E. West Vlrginia <br />3 <br />02 How This Insurance Works <br />2 <br />EXTENDED <br />OPTIONS <br />4 <br />PART _ SIX <br />2 <br />01 <br />Employers' Liability Insurance <br />4 <br />03 Transfer of Your Rights and Duties <br />2 <br />02 <br />Unintentional Failure to Disclose <br />4 <br />04 Liberalization <br />2 <br />Hazards <br />SECTION II <br />2 <br />03 <br />Waiver of Our Right to Recover from <br />4 <br />VOLUNTARY COMPENSATION <br />2 <br />Others <br />INSURANCE <br />04 <br />Foreign Voluntary Compensation <br />4 <br />05 Voluntary Compensation Insurance <br />2 <br />A. How This Reimbursement Applies <br />4 <br />A. How This Insurance Applies <br />2 <br />B. We Will Reimburse <br />4 <br />B. We Will Pay <br />3 <br />C. Exclusions <br />4 <br />C. Exclusions <br />3 <br />D. Before We Pay <br />5 <br />D. Before We Pay <br />3 <br />E. Recovery From Others <br />5 <br />E. Recovery From Others <br />3 <br />F. Reimbursement For Actual Loss <br />5 <br />F. Employers' Liability Insurance <br />3 <br />Sustalned <br />EMPLOYERS' LIABILITY STOP GAP <br />3 <br />G. Repatriation <br />5 <br />5 <br />ENDORSEMENT <br />H. Endemic Disease <br />5 <br />06 Employers' Llablilty Stop Gap <br />3 <br />05 <br />Long6hore and Harbor Workers' <br />Coverage <br />Compensatlon Act Coverage <br />A. Stop Gap Coverage Limited to <br />3 <br />Endorsement <br />6 <br />Montana, North Dakota, Ohio, <br />SECTION <br />111 <br />8 <br />Washington, West Vlrginla and <br />01 <br />Schedule of Covered States <br />Wyoming <br />Form WC 89 03 03 B Printed In U.S.A. (Ed. 8100) <br />0 2000, The Hartford <br />Page 1 of 0 <br />I:u <br />