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Version 08.19.19 Loss Fund Exhibit Orange County Page 21 <br />© (2019) The Travelers Indemnity Company. All rights reserved. <br />In connection with your Workers Compensation & Employers Liability program, we will make Plan Losses, Allocated Loss Adjustment <br />Expenses and Claims Handling Charges (together referred to as “Loss Transaction” or “Loss Transactions”) on your behalf under your <br />insurance or self-insured program using checks drawn against one of our bank accounts. You acknowledge that these Loss <br />Transactions are Obligations as defined in your Insurance Program Agreement. In exchange for our agreement to pay Loss <br />Transactions on your behalf, you agree to the following: <br />You will designate a bank and account (“Source Account”) against which monthly Automated Clearing House (“ACH”) debits <br />will be drawn by us as payment of your Loss Transactions. <br />You will provide us with the documentation authorizing Bank of America to make monthly charges and reimbursements at <br />our direction including a signed authorization letter to direct Bank of America to draw ACH debits against your Source <br />Account, along with the Source Account codes and Source Account’s bank ABA Code. <br />We will determine the amount due to us by combining the monthly Loss Transaction payments, along with any corrections <br />caused by edits on each Loss payment. This amount will be sent electronically to Bank of America with instructions to draw <br />an ACH debit on your Source Account. <br />In addition to deposit amount agreed to in the Loss Fund Requirements section of the applicable Program Exhibit, we will periodically <br />perform an analysis of Loss Transactions based upon data from our billing systems to determine the adequacy of the deposit amount. <br />If we, in the exercise of our good faith discretion, determine additional deposits to the Loss Fund Requirements are necessary, this <br />amount will be sent electronically to Bank of America with instructions to draw an ACH debit on your Source Account. Upon request, <br />we will provide you with documentation of the Loss Transactions payment analysis. <br />Reports identifying Loss(es) and Allocated Loss Adjustment Expense payments must be accessed electronically by you via e-TRACER <br />reporting. These reports identify the Loss Transactions and a premium tax, if applicable for your program with us. <br />We may automatically continue these payment and billing arrangements if your Insurance program is renewed. If your Insurance <br />program is cancelled or not renewed, we reserve the right to continue or discontinue these payment and billing. If TRACER is <br />discontinued by either of us, your program will change to a monthly billed program, and each month after TRACER is discontinued, we <br />will send you an invoice for the total amount of Loss Transactions due. Upon receipt, you will pay the amount due on or before the <br />date set forth on the invoice. <br />DocuSign Envelope ID: FCD9FE56-CF01-4E96-B983-B8E8DFE6811C