Laserfiche WebLink
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> WORKERS' COMPENSATION BROAD FORM ENDORSEMENT <br /> EXTENDED OPTIONS <br /> Policy Number: 52 wEC LP3587 Endorsement Number: <br /> Effective Date: 07/18/13 Effective hour is the same as stated on the Information Page of the policy. <br /> Named Insured and Address: THE CROSBY GROUP INC <br /> 999 BAKER WAY STE 410 <br /> SAN MATEO, CA 94404 <br /> Section I of this endorsement expands coverage provided under WC Od 00 00. <br /> 5ection 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 /> SUBJECT PAGE SUBJECT PAGE <br /> SECTION I 2 B. Part One Does Not Apply 3 <br /> PARTS ONE and TWO 2 C. Application of Coverage 3 <br /> 01 We Will Also Pay 2 D. Additional Exclusions 3 <br /> PART•THREE 2 E. West Virginia 3 <br /> 02 How This Insurance Works 2 EXTENDED OPTIONS 4 <br /> PART-SIX 2 01 Employers' Liability Insurance 4 <br /> 03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4 <br /> 04 Liberalization 2 Hazards <br /> SECTION II 2 03 Waiver of Our Right to Recaver from 4 <br /> VOLUNTARY COMPENSATION INSURANCE 2 Others <br /> 05 Voluntary Compensation Insurance 04 Foreign Voluntary Compensation 4 <br /> A. How This Insurance Applies 2 A. How This Reimbursement Applies 4 <br /> B. We Will Pay 2 B. We Will Reimburse 4 <br /> C. Exclusions 3 C. Exclusions 4 <br /> D_ Before We Pay 3 D. Before We Pay 5 <br /> E. Recovery From Others 3 E. Recovery From Others 5 <br /> F. Empioyers' Liability Insurance 3 F. Reimbursement For Actual Loss 5 <br /> EMPLOYERS'LIABILITY STOP GAP 3 Sustained <br /> ENDORSEMENT 3 G. Repatriation 5 <br /> d6 Employers' Liability Stop Gap H. Endemic Dissase 5 <br /> Coverage 3 OS Longshore and Harbor Workers' S <br /> A. Stop Gap Coverage Limited to Compensation Act Coverage <br /> Montana, North Dakota, Ohio, 3 Endorsement <br /> Washington, West Virginia and SECTION III 6 <br /> Wyoming 01 Schedule of Covered States 6 <br /> Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/40) Page 1 of 6 <br /> Process Date: 05/01/13 Policy Expiration Date: 07/18/14 <br /> O 2004, The Hartford <br />