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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C <br /> (Ed. 1-15) <br /> D. Premium Payments <br /> 4. Cooperate with us and assist us, as we may You will pay all premium when due.You will pay <br /> request, in the investigation, settlement or the premium even if part or all of a workers <br /> defense of any claim, proceeding or suit. compensation law is not valid. <br /> 5 Do nothing after an injury occurs that would E. Final Premium <br /> interfere with our right to recover from others. The premium shown on the Information Page, <br /> schedules, and endorsements is an estimate. The <br /> Do not voluntarily make payments, assume final premium will be determined after this policy <br /> 6. obligations or incur expenses, except at your own ends by using the actual, not the estimated, <br /> cost. premium basis and the proper classifications and <br /> rates that lawfully apply to the business and work <br /> PART FIVE covered by this policy. If the final premium is more <br /> PREMIUM than the premium you paid to us, you must pay us <br /> A. Our Manuals the balance. If it is less, we will refund the balance <br /> to you. The final premium will not be less than the <br /> All premium for this policy will be determined by our highest minimum premium for the classifications <br /> manuals of rules, rates, rating plans and classifications. covered by this policy. <br /> We may change our manuals and apply the changes to If this policy is canceled, final premium will be <br /> this policy if authorized by law or a governmental determined in the following way unless our manuals <br /> agency regulating this insurance, provide otherwise: <br /> B. Classifications 1. If we cancel, final premium will be calculated <br /> pro rata based on the time this policy was in <br /> Item 4 of the Information Page shows the rate and force. Final premium will not be less than the pro <br /> premium basis for certain business or work rata share of the minimum premium. <br /> classifications. These classifications were assigned 2. If you cancel, final premium will be more than <br /> based on an estimate of the exposures you would have pro rata; it will be based on the time this policy <br /> during the policy period. If your actual exposures are was in force, and increased by our short-rate <br /> not properly described by those classifications, we will cancelation table and procedure. Final premium <br /> assign proper classifications, rates and premium basis will not be less than the minimum premium. <br /> by endorsement to this policy. <br /> F. Records <br /> C. Remuneration You will keep records of information needed to <br /> Premium for each work classification is determined by compute premium. You will provide us with copies <br /> multiplying a rate times a premium basis. of those records when we ask for them. <br /> Remuneration is the most common premium basis. This <br /> premium basis includes payroll and all other G. Audit <br /> remuneration paid or payable during the policy period You will let us examine and audit all your records <br /> for the services of: that relate to this policy. These records include <br /> 1. all your officers and employees engaged in work ledgers,journals, registers, vouchers, contracts, tax <br /> covered by this policy; and reports, payroll and disbursement records, and <br /> programs for storing and retrieving data. We may <br /> 2. all other persons engaged in work that could make conduct the audits during regular business hours <br /> us liable under Part One(Workers Compensation during the policy period and within three years after <br /> Insurance)of this policy. If you do not have payroll the policy period ends. Information developed by <br /> records for these persons,the contract price for their audit will be used to determine final premium. <br /> services and materials may be used as the premium Insurance rate service organizations have the same <br /> basis. This paragraph 2 will not apply if you give us rights we have under this provision. <br /> proof that the employers of these persons lawfully <br /> secured their workers compensation obligations. <br /> 9 of 24 <br /> Ed.1-1 5 <br /> 0Copyright 2013 National Council on Compensation Insurance,Inc.All Rights Reserved. <br />