# DocuSign Envelope ID: 36857BF5-BFB0-4F33-ACA9-8E38BEA37B8

## Chubb Global Casualty

If any of the Claims Administration Expense shown in B) Premium Calculation and Adjustment is shown as deferred in II. B) Program - Payment Terms and, prior to the deferral due date, the actual claims administration expense exceeds the amount of the Claims Administration Expense Pay-In, you will pay all such additional claims administration expenses as claims are made, at the rates listed in that certain Client Agreement between the Company and the Claims Administrator. Additional Claims Administration Expense amounts you pay will reduce the amount of Claims Administration Expense that is shown as deferred.

The Rating Period means the period of time beginning on the earliest Policy effective date and ending on the latest Policy expiration date. If the Rating Period is greater than 12 months, we may make an interim adjustment to premium with loss information valued at 6 months after expiration of the Policy being adjusted. We may make an adjustment to premium with loss information valued as of any date that you are declared bankrupt or insolvent, make an assignment for the benefit of creditors, or are the subject of reorganization, receivership, or liquidation.

### 5. Reimbursable and Retrospectively Rated Losses

#### A. Paid Loss Reimbursement

Reimbursable Losses are losses subject to reimbursement through the application of a deductible endorsement on the Policies or are Losses Subject to a Loss Limitation. The Company or the Claims Adjusting Service will bill the Insured for reimbursement of paid losses and ALAE on a monthly basis, subject to the Single Payment of Paid Loss and/or Allocated Loss Adjustment Expense amount as provided for in E) Collateral & Paid Loss Deposit Fund and the Collateral Agreement executed by you and us.

#### B. Losses Subject to a Loss Limitation

When a workers compensation policy is subject to a Loss Limitation, as defined herein, the Loss Limitation applies as follows: (i) in the case of bodily injury as the result of disease, the Loss Limitation applies separately to each employee who sustains such bodily injury; and separately, (ii) in the case of bodily injury as the result of an accident, the Loss Limitation applies to the aggregate of all employees who sustain such bodily injury in a single accident or occurrence.

As shown in D) Reimbursable Losses above, you are responsible for reimbursement of loss on policies subject to a loss limit as follows:

**100% borne by the Insured:** You will reimburse the Company for each loss up to the amount of the Loss Limit plus all Allocated Loss Adjustment Expense.

Losses subject to a Loss Limitation are considered premium. The Expected Reimbursable Amount shown in D) Reimbursable Losses above is an estimate. This portion of your premium, along with any premium charge dependent upon the value of loss subject to a Loss Limitation will be adjusted using loss information valued 6 months after the Rating Period ends and annually thereafter until we make a final premium calculation. In calculating a premium adjustment we will apply loss development factors to the incurred losses limited to the Loss Limitation.

The Rating Period means the period of time beginning on the earliest Policy effective date and ending on the latest Policy expiration date. If the Rating Period is greater than 12 months, we may make an interim adjustment to premium with loss information valued at 6 months after expiration of the Policy being adjusted. We may make an adjustment to premium with loss information valued as of any date that you are declared bankrupt or insolvent, make an assignment for the benefit of creditors, or are the subject of reorganization, receivership, or liquidation.

### 6. Collateral & Paid Loss Deposit Fund

Subject to all of the terms and conditions of the Collateral Agreement or other security agreement between you and the Company, you are required to provide collateral or other security, in addition to any collateral or security that you may already have provided, as indicated in E) Collateral & Paid Loss Deposit Fund above. Additional amounts may be due at other times, all as provided in the Collateral Agreement.

The Paid Loss Deposit Fund and Collateral are subject to all of the terms and conditions of the Collateral Agreement executed by you and us.

### 7. Taxes, Non-Premium Surcharges and Assessments

The tax and non-premium surcharge and assessment charges herein are based upon the Company's current knowledge of the state's interpretation of current law. If current law or a state interpretation thereof changes, or a rate or basis of assessment changes, then the Insured and the Company agree that the Company shall have the right to amend such prior tax and/or surcharge and/or assessment charges to the Insured in order to match the state interpretation, and the Company shall bill the Insured for such retrospective taxes and/or assessments accordingly.

If audited exposures and/or adjusted premiums generate a basis of assessment for any tax, assessment, or surcharge not listed in schedule II.A) Non-Premium Surcharges and Assessments, then the Insured and the Company agree that the