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Exhibit 10.31    
    

        Binder For Casualty Insurance Program

for  

Gevity HR Inc.  

In consultation with your Representative

Marsh USA Inc.  

by  

AIG Global Risk Management  

  

	PREPARED BY:	MATT BILELLO &

TOM BECCONSALL
	DATED:	12/14/2007
	PROPOSED EFFECTIVE DATE:	1/1/2008
	VALID UNTIL:	1/1/2008

 

 

 SECTION 1—THE CONTACTS  

AIG
Risk Management is committed to providing superior service on your Insurance Program. The People listed below are the primary team representatives for your account. 

	Contact Name:	 	Christopher P. Davis, CPA, Vice President, Finance-Insurance Solutions
	Company Name:	 	Gevity HR Inc.
	Street:	 	9000 Town Center Parkway
	City:	 	Bradenton
	State:	 	FL
	Zip:	 	34202
	Telephone #:	 	941-741-4343
	

Your Representative Contact Name:	
 	

Michael C. Weiss
	Company Name:	 	Marsh USA Inc.
	Street:	 	1166 Avenue of the Americas
	City:	 	New York
	State:	 	NY
	Zip:	 	10036
	Telephone #:	 	212-245-3568
	

Our Account Representative Contact Name:	
 	

Tom Becconsall, Regional Manager
	Company Name:	 	AIG Risk Management
	Street:	 	Financial Square, 32 Old Slip
	City:	 	New York
	State:	 	NY
	Zip:	 	10005
	Telephone #:	 	646-857-1195
	

Other Important Contacts	
 	

 
	Name:	 	[*]
	Title:	 	Underwriter
	Telephone #	 	[*]
	Name:	 	[*]
	Title:	 	PEO Underwriter
	Telephone #	 	[*]
	Name:	 	[*]
	Title:	 	Account Manager
	Telephone #	 	[*]
	Name:	 	[*]
	Title:	 	Fusion Account Services Executive
	Telephone #	 	[*]
	Name:	 	[*]
	Title:	 	Risk Analyst
	Telephone #	 	[*]

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

2

 

 SECTION 1—POLICY NUMBERS, POLICY COMPANIES  

	Policy Number
 
	 	States Covered
	 	Company Written In
	 	Type of Coverage

	WC Various	 	Various	 	VARIOUS	 	Statutory Workers' Compensation and Employers' Liability
	GL 1595769	 	All States	 	AMERICAN HOME ASSURANCE COMPANY	 	General Liability (Liability other than Automobile)
	CA 160732	 	FL	 	AMERICAN HOME ASSURANCE COMPANY	 	Automobile Liability

ACKNOWLEDGED ON BEHALF OF:  

This
Binder is intended to be a statement of the mutual interest of the parties with respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program
described above and is subject to execution and delivery of a mutually satisfactory Payment Agreement, RCAMP Agreement, and Collateral Trust Agreement. The parties will become legally obligated with
respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program described above only in accordance with the terms contained in the Payment Agreement,
RCAMP Agreement and Collateral Trust Agreement relating thereto if, as and when such document has been executed and delivered by the parties. 

SIGNATURES

	Signed by	/s/  THOMAS BECCONSALL      
 Thomas Becconsall
 Regional Manager,
AIGRM National Accounts	 	Signed by	/s/  GARRY J. WELSH      
 Garry J. Welsh
 Chief Financial Officer,
Gevity HR Inc.
	

Dated	

12/14/2007	
 	

Dated	

12/14/2007

3

 

 

 SECTION—2—INFORMATION ABOUT AIG NATIONAL ACCOUNTS DIVISION

 
 

AIG Risk Management—National Accounts Division    
    

For
more than 20 years, AIG Risk Management (AIGRM) has been known in the marketplace as the leading provider of sophisticated risk management programs for large, national accounts. Our
National Accounts Division focuses on corporations with annual revenue in excess of $750 million. AIGRM professionals can devise integrated risk management programs for most hazards and
exposures in your operations. In designing a customized program for our clients, we explore a variety of financing and coverage options: guaranteed cost; self-insured retention; large
deductibles; incurred-loss and paid-loss retention plans; and captive arrangements. Buy-outs and loss portfolio transfers are handled by a separate profit center
within AIG Risk Management (Division 86). We can also combine and/or coordinate our program with a spectrum of products and services available within the diverse member companies of American
International Group, Inc. (AIG), allowing us to create a comprehensive program that meets most, if not all, of your risk management needs. Our creative approach to solving our clients' simplest
to most difficult problems has propelled us to be a market leader in risk management solutions for national corporations. 

 
 

Quality Service    
    

In
2002, The Risk and Insurance Management Society awarded AIG the Arthur Quern Quality Award in recognition of AIG's Performance Management Program. Our excellence is rooted in the belief that a
quality insurance program entails more than just sound underwriting; it also requires customer-driven service. Each AIGRM client is assigned an Account Manager who focuses on your business strategies,
understands your needs, and works with you to find solutions to your risk concerns. We will work with AIG Claim Services, Inc. or your chosen third party administrator to provide an effective
cost-containment program. Our AIG Risk Consultants team is unmatched in its loss control and loss prevention expertise. Additionally, we offer a variety of specialized services to enhance
your risk management programs, including IntelliRisk©, our on-line claims management system. AIGRM professionals provide a full range of services to help you manage and control
your overall cost of risk. 

 
 

Financial Strength    
    

The
AIG Companies' ratings are among the highest of any insurance and financial services organization in the world. The AIG Companies provide the most extensive range of commercial and industrial
coverages available for corporate and commercial customers, from large multinationals to small businesses. The AIG Companies are longtime market leaders in most lines, including the most complex
insurance lines. We typically provide the highest insurance limits available and are first to address new or emerging risks. Policies underwritten by the AIG Companies provide highly-rated financial
strength, and specialized claims and loss control services. AIG Companies refers to the domestic property and casualty insurance subsidiaries of American International Group, Inc. 

4

 

 SECTION 2—PROGRAM RATES AND PREMIUMS  

        Rates and Estimated Premiums for:

	Line of Business
 
	 	Rating Segment
	 	Coverage Plan Type
	 	Claims Administrator
	 	Retention/

Deductible
	 	Estimated Losses

	General Liability (All Options)	 	The Entire Contract	 	Deductible	 	AIGCS	 	$	500,000	 	[*]
	Automobile Liability (All options)	 	The Entire Contract	 	Deductible	 	AIGCS	 	$	500,000	 	[*]

	 

	Line of Business
 
	 	Rating Segment
	 	Coverage Plan Type
	 	Claims Administrator
	 	Retention/ Deductible
	 	Estimated Losses

	Workers' Compensation	 	The Entire Contract	 	Deductible	 	AIGCS	 	$	1,000,000	 	[*]
	Workers' Compensation	 	The Entire Contract	 	Full Coverage Retention—WI, WY	 	AIGCS	 	$	1,000,000	 	[*]
	Workers' Compensation	 	FL, TX and OR Loss Re	 	Deductible Non-LRRP	 	AIGCS	 	$	1,000,000	 	[*]

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.

5

 

 SECTION 2—PROGRAM RATES AND PREMIUMS  

Estimated Subject Premium

	Line Items
 
	 	Rates
	 	Per
	 	Basis Types
	 	Estimated Basis
	 	Minimum Premium
	 	Estimated Premium

	Forecast of Subject Losses in Final Premium	 	N/A	 	1	 	Ultimate Losses	 	$0	 	N/A	 	[*]
	Insurance Charge	 	[*]	 	1	 	Unmodified Premium excl. FL, TX & OR	 	[*]	 	[*]	 	[*]
	WC Profit & Administration	 	[*]	 	1	 	Unmodified Premium excl. FL, TX & OR	 	[*]	 	[*]	 	[*]
	WC Claims Service Fee	 	Flat	 	Flat	 	N/A	 	FLAT	 	[*]	 	[*]
	WC Taxes, B&B and RMLs	 	[*]	 	1	 	Unmodified Premium excl. FL, TX & OR	 	[*]	 	N/A	 	[*]
	NYS WC Assessment	 	[*]	 	1	 	NY Standard Premium	 	[*]	 	N/A	 	[*]
	AL Profit & Administration	 	Flat	 	Flat	 	N/A	 	FLAT	 	[*]	 	[*]
	AL Claim Service Fee	 	Flat	 	Flat	 	N/A	 	FLAT	 	[*]	 	[*]
	AL Taxes, B&Bs, RMLs	 	Flat	 	Flat	 	N/A	 	FLAT	 	N/A	 	[*]
	GL Profit & Administration	 	Flat	 	Flat	 	N/A	 	FLAT	 	[*]	 	[*]
	GL Claim Service Fee	 	Flat	 	Flat	 	N/A	 	FLAT	 	[*]	 	[*]
	GL Taxes, B&Bs, RMLs	 	Flat	 	Flat	 	N/A	 	FLAT	 	N/A	 	[*]
	Estimated Subject Premium	 	$4,758,091

Estimated Non-subject Premium

	Coverage Description
 
	 	Rates
	 	Per
	 	Basis Types
	 	Estimated Basis
	 	Minimum Premium
	 	Estimated Premium

	AL Excess Premium	 	Flat	 	Flat	 	N/A	 	FLAT	 	[*]	 	[*]
	GL Excess Premium	 	[*]	 	[*]	 	Sales	 	[*]	 	[*]	 	[*]
	WC Excess Premium	 	[*]	 	1	 	Unmodified Premium excl. FL, TX & OR	 	[*]	 	[*]	 	[*]
	Florida WC Standard Premium/ Loss Reimbursement Premium	 	1	 	1	 	Standard Premium*	 	[*]	 	N/A	 	[*]
	Texas WC Standard Premium/ Loss Reimbursement Premium	 	1	 	1	 	Standard Premium*	 	[*]	 	N/A	 	[*]
	Oregon WC Standard Premium/ Loss Reimbursement Premium	 	1	 	1	 	Standard Premium*	 	[*]	 	N/A	 	[*]
	Estimated Non-Subject Premium	 	$11,444,503

Summary of Expected Cost

	Estimated Premium (Subject and Non-subject)	 	$16,202,594
	Expected Reimbursable Losses/ Deductible Loss/Self-Insured Losses and ALAE, if applicable	 	[*]
	Credit Fee	 	[*]
	Estimated Surcharges:	 	[*]
	Estimated Cost	 	[*]
	Total Pay-In Premium & Surcharges During the Policy Period	 	$16,666,113

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.

6

 

Surcharge
(breakdown by state excluding NYS Work Comp Assessment): 

	FL	 	AL	 	[*]	 	MN	 	WC	 	[*]
	FL	 	GL	 	[*]	 	MO	 	WC	 	[*]
	CA	 	WC	 	[*]	 	MT	 	WC	 	[*]
	CT	 	WC	 	[*]	 	NJ	 	WC	 	[*]
	GA	 	WC	 	[*]	 	NY	 	WC	 	[*]
	IL	 	WC	 	[*]	 	PA	 	WC	 	[*]
	IN	 	WC	 	[*]	 	SD	 	WC	 	[*]
	KY	 	WC	 	[*]	 	VT	 	WC	 	[*]
	MA	 	WC	 	[*]	 	OR	 	WC	 	[*]
	ME	 	WC	 	[*]	 	Total:	 	$463,519	 	[*]

	 

	Terrorism Charges Included in Premium By Line of Business:
 
	 	Estimated Charge

	 	Workers' Compensation (TRIA)	 	[*]
	 	General Liability (TRIA)	 	[*]
	 	Automobile Liability (Terrorism)	 	[*]

If UM/UIM/PIP forms (as referenced in Section 3) are not signed and returned by effective date, an additional premium of $100,000 will be charged and the Automobile
Liability rate will be increased by $N/A by power unit.

[* [*]

The Binder (Binder) contemplates the following terms:

	1.
	Based
on unmodified manual premium of $81,221,287 with corresponding estimated modified premium of $85,314,687 including FL, TX and OR. Rates outlined within this Binder (binder) will
be applied to unmodified manual premium. Due to pending CA, FL and other state pending rate changes, the LRRP & deductible credits will be amended once the rates are finalized. This will be
done in concert with the AIG Rate Filings. Taxes, surcharges and assessments are subject to change based on updated rates as well as premiums.

	2.
	Receipt
of first installment due prior to inception.

	3.
	Annual
manual premium growth of no more than [*] in the states of CA, NJ, TX, or FL([*] as respects FL) individually and no more than
[*] in the aggregate. If calculated at monthly audit [*] or greater premiums are found for states other than FL (FL is [*]), we
would retain the right to immediately increase and bill excess premium and collateral by [*] times the relative exposure in the applicable states above the trigger.

	4.
	If
actual surcharges including NY second injury exceed the deposit indicated above, Gevity will be responsible for the additional cost.

	5.
	Continued
compliance with monthly voluntary audits.

	6.
	This
Binder (Binder) contemplates that there are no material changes between the date of this Binder and expiration. If a material change should occur, we reserve the right to
re-price account immediately and change our collateral requirements. Material change is defined as inclusive but not limited to: changes in management team, changes in manual rate profile
of Gevity, deterioration in either Gevity's financials or projected losses under the current program, acquisitions or transfer in whole or in part of another similar organization or book of business,
any breach of our current contract.

	7.
	This
Binder (Binder) is net of brokerage commission. 

Data Reporting Requirements

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.

7

 

  Gevity must report the renewal client base and, on a weekly basis, all client additions, terminations and endorsements using the PEO standard template and the FTP server. See
PEO standard template attached.

Claim Fees

ý
Claim Service Fee is a FLAT CHARGE for AL, GL and WC states subject to Large Risk Rating Plan (all states other than FL, TX and OR for workers'
compensation) AND Included in Loss Reimbursement Standard Premium shown for FL, TX and OR. 

	IntelliRisk Services Included

	Category
 
	 	Project
	 	Description/Comments

	Risk Management Information System	 	IntelliRisk NetSource—Gevity	 	8 IntelliRisk NetSource Risk Management Package licenses.
	 	 	User Security	 	Utilization of the IntelliRisk NetSource User Security feature, which allows Gevity to control claim access by location code and line of business.
	 	 	Upgrades/New Releases of IntelliRisk NetSource	 	Non client-specific upgrades/new releases of IntelliRisk NetSource.
	
RMIS Support	
 	

Help Center	
 	

RMIS Help Center support is available 8am-8pm ET Monday-Friday, during regular AIGCS business days.
	 	 	Solution Development Team Support	 	RMIS Solution Development Team support includes dedicated resources with the RMIS dept., quality assurance process for custom solutions, training, travel & expenses exclusive of supplemental custom
reporting.
	
Data Transmission and Maintenance	
 	

Gevity—Monthly Detail Dataset Creation and Transmission	
 	

Monthly creation and transmission of claim data via FTP to Gevity. File includes 5 additional data elements requested by Gevity.
	 	 	STARS—Monthly Transactional Dataset Creation and Transmission	 	Monthly creation and transmission of claim data via FTP to STARS. File includes 50 additional data elements requested by Gevity/Stars.
	 	 	Data Maintenance	 	Record Storage/Mainframe Processing
	 	 	 	 	CDE Maintenance
	
Custom Projects	
 	

Client Location File	
 	

Daily FTP intake of Client Location File from Gevity to AIGDC and First Health. Custom programming and maintenance of daily feed from Gevity includes file processing costs and generation of exception reports.

Aggregate Stop Amount and Aggregate Stop Limit Schedule

The
"Aggregate Stop Amount "and the "Aggregate Stop Limit "(if one is applicable) apply to the
o first year of, or ý entire Rating Period. 

Line(s) and Insurance Included: Worker's Compensation and Employers Liability 

8

 

"Aggregate
Stop Amount" is the minimum amount and adjustable on the Basis and rate shown below: 

	Deductible Level
 
	 	"Aggregate Stop Amount"
	 	Rate (per $1 of unmodified premium, $81,221,287.)
	 	"Aggregate Stop Limit"

	$	1,000,000	 	$	138,500,000	 	[*]	 	$	20,000,000

"Aggregate
Stop Amount" means the maximum amount of: 

Benefits,
damages and ALAE (per the ALAE option selected herein) payable by you for losses under
policies issued that are subject to your retention/deductible/loss reimbursement program, and if applicable, self-insured retention program. 

Adjustment: The final "Aggregate Stop Amount" will be determined by our audit of your books and records. In no event will the "Aggregate Stop Amount" be
less than the Estimated Amount shown. 

"Aggregate
Stop Limit" means the maximum amount of: 

Benefits,
damages and ALAE (per the ALAE option selected herein) above the Aggregate Stop Amount that we
will not require you to reimburse us for under your retention/deductible/loss reimbursement program, and if applicable, self-insured retention program. 

Note:

Self-Insured Losses means any loss you incur under a Self-Insured Retention. Losses you Incur for which no coverage is available under the
Self-Insured Retention policy(ies) will NOT be included in determining whether or when the "Aggregate Stop Amount" or "Aggregate Stop Limit" has been reached.

Underwriting Guidelines

	1)
	At
a minimum we will not provide coverage for the following:

	•
	[*]

	•
	[*]

	•
	Undesirable Classes  

	•
	[*] 
	•
	[*] 
	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*] 
	•
	[*] 
	•
	[*] 
	•
	[*] 
	•
	[*]

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.

9

 

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	•
	[*]

	2)
	The
following clients must be referred to AIG for approval:

	•
	[*]. 
	•
	[*].

	•
	[*].

	3)
	Referral
Items:

	•
	[*]

	•
	[*]

	•
	[*] 
	•
	[*] 
	•
	[*] 
	•
	[*] 

Special Conditions

You
must execute and return an original executed copy of both the Payment Agreement and the Schedule, and any other documents we deem necessary to adequately document the terms of the program, to us
at our address shown above within 30 days after the Effective Date above. 

If
not so returned and delivered, we may void the Finance Plan summarized herein and set forth in detail in the Payment Agreement. Upon our notice of our voiding of the Finance Plan to you at your
address shown above, the entire amount of the "Estimated Total Cost" specified under FINANCE PLAN herein will become immediately due and payable to us in cash at our address shown above. Failure to
pay such amount within 10 days thereafter shall entitle us to cancel the insurance and any reinsurance and to terminate all services under this Program by notice to you when not less than
10 days thereafter the cancellation and termination shall become effective. 

Claims Administration

Claims
will be handled by AIG Claims Services, Inc. The claims administration pricing is included in the insurance company expenses. Rehabilitation and managed care services are billed
separately at prevailing rates. Claim Investigations conducted by the Investigative Services Division to assist the claims adjusters are an allocated expense and charged to the file at Prevailing
Time & Expense. Fraud investigations conducted for the purpose of criminal prosecution are not billed to the file and considered part of the overall claim fee. 

The
claims administration charges include four intellirisk setups and 12 monthly tape to tape triangles to Marsh STARS system. If the program does not renew, AIG agrees to continue to provide
access to Intellirisk setups and monthly tapes as long as Gevity requires, at prevailing rates. Also if the program does not renew, AIG will continue to grant access to data and tape to tape triangles
to Marsh at prevailing rates. When requested, we will provide these rates to Gevity. Where possible, we will offer fixed rates for 3 years. 

Allocated
loss adjustment expenses, as defined above, are not included in the Insurance Company expenses. 

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.

10

 

  Loss Control Services

We
understand that Gevity HR's loss control professionals are providing ongoing loss control services to your clients and that additional loss control services have not been requested as part of the
AIG program. Only those loss control surveys needed for underwriting purposes and those services mandated by state regulatory requirements will be included in the AIG program. Of course, additional
loss control services can be provided on an unbundled basis at any point during the policy year. 

AIG
Consultants will provide a Technical Services Manager—[*]—to manage the delivery of all services. We maintain a nationwide network of
loss control consultants to provide service at your key clients' facilities, which can serve as a cost effective complement to the work done by Gevity's field risk consultants. AIG
Consultants, Inc. can provide personnel with experience and expertise commensurate with the services needed. Ergonomic and/or industrial hygiene specialists can be provided as appropriate.
Consultant training and/or specialty training in industrial hygiene/ergonomics can be provided to your field risk consultants. To ensure readily available competent consultants near our clients
various locations, we maintain a complement of approved subcontractor consultants to supplement our internal loss control professionals. These subcontractors are subject to our Quality Management
System approval process as a requirement of AIG Consultant's Inc. ISO 9000 certification. 

Cancellation

If
AIG were to initiate cancellation and or non renewal of the entire PEO program we would provide advance notice to the Broker and the PEO of 120 days but that actual issued WC policies will
be cancelled and or non renewed based upon the WC statutory requirements. 

Coverages

A
specimen policy will be prepared for the MCP states with all appropriate forms attached and this will serve as the master sample for each of those states where multiple policies are required. 

All
endorsements may not be approved for use in all states and we can only include those endorsements where they are approved. 

Named
insured will include all Gevity HR, Inc. affiliated or subsidiary entities for which payroll are reported to AIG Risk Management shown as follows: 

Gevity HR, Inc. and it's wholly-owned subsidiaries:  

	Gevity HR, L.P.	 	Gevity HR II, LP.	 	Gevity HR, III, LP.	 	Gevity HR IV, L.P
	

Gevity HR V, L.P.	
 	

Gevity HR VI, L.P.	
 	

Gevity HR VII, L.P.	
 	

Gevity HR VIII, L.P.
	

Gevity HR IX, L.P.	
 	

Gevity HR X, L.P.	
 	

Gevity HR XI, LLC	
 	

Gevity HR XII Corp.
	

Gevity HR XIV, LLC	
 	

Gevity Insurance Agency, Inc.
	

Staff Leasing, LLC.	
 	

Concorda Insurance Company Limited

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

11

 
Security Plan

Collateral 

	Collateral on Hand (by Type)
 
	 	Amount of Collateral
	 	 

	 	RCAMP Cash	 	[*]	 	 
	 	RCAMP Non-Depleting Cash Trust	 	[*]	 	 
	 	Trust Funds	 	[*]	 	 
	 	Escrow	 	[*]	 	 
	Estimated Gross Amounts of Collateral on Hand	 	$141,040,340	 	At 10/1/07

	 

	Additional Collateral Required (by Type)
 
	 	Amount of Collateral
	 	Due Date

	Collateral included in Subject Workers' Compensation Premium for WI, WY full coverage retention losses:	 	[*]	 	1 Installment due on 1/1/2008
	RCAMP (paid by captive)	 	[*]	 	12 Installments due on the 1st of each month starting with 1/1/2008.
	Total Additional Collateral Required	 	$55,510,000 ($1,000,000 ded)	 	12 Installments due on the 1st of each month starting with 1/1/2008.
	Estimated RCAMP return via lump sum to captive	 	[*]	 	Date of Return TBD
	Estimated Gross Amount of Collateral Required	 	$53,510,000 ($1,000,000 ded)	 	 

(AIG acknowledges that in addition to the above amounts, the unused portion of the 2007 DBB policy which is available to pay losses is
[*] as of 9/28/2007.) 

Collateral Reviews

We
will review our collateral requirement annually. In addition, we may review our collateral requirement at any time that we may deem reasonably necessary. If as a result of any review we find that
we require additional collateral, you will provide us such additional collateral within 30 days of our written request, which shall be accompanied by a worksheet showing our calculation of the
amount thereof. If a return of collateral to you is indicated, we will return annually the indicated amount to you within 30 days of our written acknowledgement thereof. 

The Additional/Return Collateral at adjustment will be: The difference between the Ultimate Losses and Loss Provision amount collected during the policy
period.

Specific Loss Development Factors

We
have agreed to use specific Loss Development Factors in determining Ultimate Losses in our collateral calculation, at the annual adjustment of the 2008 program the following apply: 

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

12

 
GRID of Loss Development Factors

	Valuation Date
 
	 	DEDUCTIBLE LEVEL

	 	 	$1,000,000
	6/30/09	 	[*]
	6/30/10	 	[*]
	6/30/11	 	[*]
	6/30/12	 	[*]
	6/30/13	 	[*]
	6/30/14	 	[*]

At
1/1/15, if requested, we will consider additional loss development factors. 

NOTE THAT:  

We
may apply a different table of LDF's that will enable us more accurately to determine the Ultimate Losses in the security calculation, if during the term of the policies, a change occurs in the
hazards insured against because of Your acquisition or disposition of a subsidiary, division or operation with assets at least equal to 20% of  your assets
on the effective date hereof, or the organization that provides claims service under the Policies is
changed, or Your retention/deductible/loss reimbursement limit under any of the  Policies, or any other change occurs which is
likely to render the LDF's shown in the Grid ineffective as a tool for estimating with reasonable accuracy
the amount of Loss and ALAE that we will pay because of accidents, occurrences, or offenses covered by
the Policies.

Security
will be on a depleting basis. Using the Hybrid RCAMP as collateral, retained losses will be paid out of the Hybrid RCAMP. No monthly loss billings will go to the insured. 

The
collateral pay-in during the 1/1/08 - 1/1/09 period will be reviewed on a quarterly basis during the policy period. If the unmodified premium reported to the
PEO unit is more than 110% of the estimated unmodified premium for that quarter, then the collateral and expense dollars will be adjusted. The collateral will be adjusted based on the following
formula. 

Annual
countrywide unmodified manual premium × 0.6834 = Total Collateral Requirement 

The
expenses will be adjusted based on the factors in section 2 of this binder or the applicable LRRP endorsement attached to the policy. 

The
Total Collateral requirement is subject to a minimum of 100% of collateral amount above until the first loss provision annual adjustment at 18 months after inception for 2008-09
program year. The minimum is not the minimum collateral amount AIG must hold at any given time over the first eighteen months, but instead the amount that must be paid in over the first year. In other
words, if the unmodified manual premium after the twelfth monthly adjustment is so low that it triggers the minimum, AIG will compare the minimum to what was submitted in collateral over the year, in
lieu of to what was on hand after depletion for paid losses. 

If
the program does not renew, then the collateral will be adjusted annually in accordance with the terms outlined in the Payment Agreement and there will be no return of collateral until
30 months from inception. 

The Hybrid RCAMP portion of this deal will be structured as follows:  

We
will issue You Deductible Policies. Your captive, in turn, will issue You a Deductible Reimbursement Policy providing coverage for the same liabilities referenced in the policies we issue to you
for the per occurrence amount equal to the deductible. 

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION  

13

 

 

Under the Hybrid RCAMP collateral option, You assign your rights under the captive issued Deductible Reimbursement to Us. Furthermore, We will reinsure Your captive for liabilities it assumes under
the Deductible Reimbursement Policy. 

This
deal will be documented via an Assignment Agreement, Reinsurance Quota Share Agreement and the Payment Agreement/Schedule of Policies & Payments. The Assignment Agreement and the cash
premium received via this reinsurance transaction will service to collateralize Your Deductible Obligations to Us. As an alternative to the Assignment Agreement we will accept a copy of the captive
issued Deductible Reimbursement Policy with the Restriction of Right to Cancel endorsement attached. 

The Captive has two Investment Selection options at its disposal which are referenced below. We will advise rate for option #2 after first installment is received. If the
captive does not make a selection within 1 business date from that time, then the One-Year Rate option will apply.

Investment Selection Options  

	1.
	One-Year
rate 

Under
this option, We would guarantee a fixed rate of return on the Reinsurance Premium set at an enhanced spread of [*] basis points over the 6-month
U.S. Constant Maturity Treasury yield as it reads the day we are in receipt of the first installment of the Reinsurance Premium. The interest rate will reset annually based on then current market
conditions. Should the Captive cancel the Reinsurance Quota Share Agreement at any time prior to January 1, 2009, it is understood and agreed that interest will be deemed to have accrued from
the date the premium is delivered to us, to the date of cancellation, at the 1-month U.S. Constant Maturity Treasury yield as it read the day we were in receipt of the first installment of
Reinsurance Premium. 

	2.
	Interest
rate payable until all claims are closed: 

Said
interest shall accrue to this account at a rate of TBD%. The rate will be effective until all claims are closed. Upon settlement of all liabilities to which this Agreement applies we shall pay to
You the balance of funds in this account. Interest will accrue to the collateral and will be paid annually. Note that accrued interest paid to the captive will not exceed the rate associated with the
amount of time that has elapsed, as per the below referenced Interest Rate Penalty Schedule. Should you choose to secure the payment of your Obligations with an alternative form of collateral prior to
all claims are closed, interest shall be calculated at the rate specified in the Interest Rate Penalty Schedule listed below in accordance to the date of the conversion to an alternative form of
collateral. 

Interest Rate Penalty Schedule  

A
penalty rate will apply. Below is a sample rate based on a rate of 5.01%, and penalty schedule will be provided when rate is set. 

	Cancellation Date
 
	 	Interest rate
	 	Cancellation Date
	 	Interest rate
	 
	Prior to 12/31/2008	 	3.50	%	1/1/2014 to 12/31/2014	 	4.30	%
	1/1/2009 to 12/31/2009	 	3.60	%	1/1/2015 to 12/31/2015	 	4.45	%
	1/1/2010 to 12/31/2010	 	3.70	%	1/1/2016 to 12/31/2016	 	4.60	%
	1/1/2011 to 12/31/2011	 	3.85	%	1/1/2017 to 12/31/2017	 	4.75	%
	1/1/2012 to 12/31/2012	 	4.00	%	1/1/2018 to 12/31/2018	 	4.95	%
	1/1/2013 to 12/31/2013	 	4.15	%	1/1/2019 to All Claims Closed	 	5.01	%

	*
	THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.

14

 

Under
either Investment Selection Option, the Captive will receive a monthly accrued interest statement, detailing the opening fund balance, less losses paid in each particular month, along with
interest earned on the average investable balance. This Binder contemplates that we will not collect Escrow. Therefore, the monthly accrued interest statement will evidence
losses being paid at the mid-point of each month.

Should
the Federal Reserve lower the targeted Federal Funds rate at any time prior to the receipt of the first installment of the reinsurance premium, both investment selection options will become
null and void. 

Letter of Credit

Any
letter of credit must be clean, unconditional, irrevocable and evergreen. It must be from a bank that we and the Securities Valuation Office of the National Association of Insurance Commissioners
have approved and in a form acceptable to us. It must be in the amount shown in the Schedule. If any letter of credit is canceled, no later than
30 days before that letter of credit expires, You must deliver to us a substitute letter of credit that complies with the requirements set forth
above. Upon Your written request, we will not unreasonably withhold our consent to a reasonable extension of the time within which  You must deliver such a
substitute letter of credit to us. The substitute letter of credit must take effect no later than the date of termination of the
expiring letter of credit. Your duty to deliver such a letter of credit will continue until You have
satisfied all Your obligations under this Agreement and the Policies. If  You fail to provide us with a
qualifying substitute letter of credit as indicated above, we may draw upon the existing letter of credit in full. 

Non-Depleting Cash Security

Cash
posted by you will be placed in a pooled cash account. We will credit to you, interest accrued for the quarter on the daily cash balances calculated at a rate equal to the 3-month
United States Constant Maturity Treasury yield as it reads the day the cash is received. The rate will be effective to 01/01/2009. This cash will not be utilized to pay for losses and expenses you
incur. We will bill you on a monthly basis for the reimbursement of losses and expenses. If, prior to 1/1/2009, you should choose, with our consent, to secure your Payment Obligation with an
alternative form of collateral provided for by the terms of the Payment Agreement ("Collateral Swap"), interest will be deemed to have accrued from the day the cash is received to the date of the
Collateral Swap, at a rate of 1.00% 

Depleting Cash Security

Cash
posted by you will be placed in a pooled cash account. We will credit to you, interest accrued for the quarter on the daily cash balances calculated at a rate equal to the 1-month
United States Constant Maturity Treasury yield as it reads the day the cash is received. The rate will be effective to 01/01/2009. This cash will be utilized to pay for losses and expenses you incur.
Should the balance fall below a predetermined amount, as determined by us, we will commence billing you monthly for reimbursement of losses and expenses. If, prior to 01/01/2009, you should choose,
with our consent, to secure your Payment Obligation with an alternative form of collateral provided for by the terms of the Payment Agreement ("Collateral Swap"), interest will be deemed to have
accrued from the day the cash is received to the date of the Collateral Swap, at a rate of 1.00%. 

Collateral Trust

Cash
will be invested in various securities, selected by you, in accordance with the applicable trust agreement, executed between you (Grantor), us (Beneficiary) and the bank (Escrow Agent). Our
oversight fee charge for this arrangement will be between 7 and 10 basis points of the market value of the trust. The Escrow Agent may also ask you for a separate fee for their services. At our
discretion, we will determine if this cash will, or will not, be utilized to pay for losses and expenses you incur. 

15

 
 
 

The Statements made are Subject To The Following Terms and Conditions:    
    

Collateral
options are subject to prior approval by AIG Credit. 

Financial Covenants, Tests, or Minimum Credit Ratings

We
may require additional collateral from You in the event of the following: 

	a.)
	Credit
Trigger:

	i.
	If
the credit rating of the entity named below and for the type of debt described below, promulgated by Standard & Poor's Corporation ("S&P") or by Moody's
Investors Services, Inc. ("Moody's"), drops below the grade shown respectively under S&P or Moody's;

	ii.
	or
If S&P or Moody's withdraws any such rating. 

We
may require and You must deliver such additional collateral according to the Payment Agreement up to an amount such that our unsecured exposure will
not exceed the amount shown as the Maximum Unsecured Exposure next to such rating in the grid below. 

"Unsecured
exposure" is the difference between the total unpaid amount of Your Payment Obligation (including any similar obligation incurred before the
inception of the Payment Agreement and including any portion of Your Payment Obligation that has been deferred and is not yet due) and the total amount
of Your collateral that we hold. 

Name of Entity:                        Type of Debt Rated: N/A 

	Ratings at Effective Date

	S&P
 
	 	Moody's
	 	Unsecured Exposure at Effective Date

	 	 	 	 	$

	 

	Potential Future Ratings

	S&P
 
	 	Moody's
	 	Maximum Unsecured Exposure

	 	 	 	 	$

	b.
	Other Financial Tests or Covenants: N/A 

16

 

 

 SECTION 3—LIMITS, PROGRAM & COVERAGE  

General Notes About Coverages

Coverage
outlined in this document is for explanatory and reference purposes only. The coverage provisions do not necessarily conform to any specifications furnished in the submission received from
your representative. 

The
policy (or policies) that we issue to you shall contain the full and complete terms, conditions, exclusions and coverages provided under your insurance program. In the case of any conflict between
the insurance policy (or policies), and the provisions contained in this Binder or binder, the provisions in the policy (or policies) shall govern. Upon receipt, please review the policy (policies)
thoroughly with your broker, and notify us promptly in writing if you have any questions or concerns. 

The
calculation of premiums, and other program features, included in this document have been established based upon the information provided by you and your representative. Additional locations,
changes in exposure, or other variations may make it necessary to re-evaluate the Binder/Binder, premium calculations and plan factors. Any modification we make shall be based on our
evaluation of these changes and whether they represent a measurable difference from the insurance program originally contemplated at inception. 

While
it is our intention to honor the terms and conditions of our contract with you, we are required to follow all regulatory and filing requirements in effect for various states where you have an
exposure. We shall adhere to all state regulatory requirements. We shall not issue any form, or apply any program, that is in contravention to a governing regulation, rule, statute or law. 

Prior
to the inception date of coverage, you must provide us with the following information: All applicable FEIN numbers, DMV reporting information (other than New York), Florida Acord 130 for Florida
Workers' Compensation coverage (fully completed, executed and notarized), and UAIN. 

Florida
Acord 130 

Please
be aware that in conjunction with your obligation to complete the Florida Workers Compensation Application [Accord form 130 FL (2002/07)] ("Application"), you are
subject to the continuing obligation as required under Florida Statutes, Chapter 443, to provide us, as your workers' compensation carrier, a copy of your quarterly earnings reports and
self-audits supported by the quarterly earnings reports ("Reports"). 

While
you bear responsibility for additional obligations as set forth under Florida law and the terms of the Application, it is hereby required that you provide us with copies of the Reports at the
end of each quarter. 

Nothing
herein is intended to modify, eliminate or amend any requirement you have to Provide us with information as detailed by the terms of the Application. 

AIG acknowledges that the Florida Acord 130 has been received and that we do not expect a new form for the 2008 renewal.

Entities
included as Named Insureds are those shown as such on the policy (policies) Declaration page, as well as in the appropriate Named Insured Endorsements attached to each individual policy,
whether such are issued at inception, or included by an additional endorsement thereafter. 

Any
questions regarding this Binder or Binder should be directed to Our AIG Risk Management Representative shown in this document. No Alterations to this Binder or Binder May
Be Made Without the Prior Written Approval of AIG Risk Management.

17

 

 

 
 

Workers' Compensation    
    

Policy
Term: Effective at 12:01
AM            1/1/2008                        to   
         1/1/2009
 

	Workers' Compensation Coverage
 
	 	Statutory

	Employers Liability:	 	 	 
	Bodily Injury by Accident—Each Accident	 	$	2,000,000
	Each Employee Bodily Injury by Disease	 	$	2,000,000
	Policy Limit Bodily Injury by Disease	 	$	2,000,000
	States Covered: AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MD, ME, MA, MI, MN, MO, MS, MT, NE, NH, NJ, NM, NV, NY, NC, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI
(i.e. Item 3A) WY is covered where approved by statute	 	 	 
	

Stop Gap Liability:	
 	
 	

 
	Bodily Injury by Accident—Each Accident	 	$	2,000,000
	Each Employee Bodily Injury by Disease	 	$	2,000,000
	Policy Limit Bodily Injury by Disease	 	$	2,000,000
	States Covered: OH, ND, WA, WV, WY, (i.e. other states covered 3C)	 	 	 

	 

	 
	 	Deductible/Loss Reimbursement Amount
	 	Applicable To:

	Workers' Compensation and Employers Liability under State Law—Insured States	 	$	1,000,000	 	Each Accident or each Person for Disease
	Workers' Compensation and Employers Liability under Federal Law—Insured States	 	$	1,000,000	 	Each Accident or each Person for Disease
	Workers' Compensation and Employers Liability—Self Insured States	 	$	N/A	 	Each Accident or each Person for Disease
	Employers Liability—Monopolistic States	 	$	1,000,000	 	Each Accident or each Person for Disease

Note: 1)For Insured States, the limit of coverage as shown in this document include(s) the Retention/Loss Reimbursement Limit layer amount(s) retained by the
Insured. 2) For Self-Insured States, the limits of liability shown are in excess of the Self Insured Retention amount.
3) Aggregate Limits apply where applicable.

	Coverage Extensions and Exclusions

	Form #
 
	 	Edition Date
	 	Name
 

	WC 00 00 00 A	 	 	 	Workers Compensation Insurance Policy
	Various	 	 	 	All Mandatory State Endorsements
	WCOFAC	 	07/05	 	OFAC Policy Holder Notice
	WC 000104	 	04/84	 	FEDERAL EMPLOYERS LIABILITY ACT COVERAGE
	 	 	 	 	•	This endorsement continues to be used in New Jersey and Texas.
	 	 	 	 	 	The remaining states approved the newer version WC 000104A (10-04).

18

 

	WC 000104A	 	10/04	 	FEDERAL EMPLOYERS LIABILITY ACT COVERAGE
 This endorsement is approved in Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, DC, Florida, Georgia, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan (exempt from filing), Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Oklahoma, Oregon,
Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
	

 	
 	

 	
 	
New Jersey and Texas will continue to use the prior version WC 000104 (4-84) until the AIG adoption filing is approved.
	

WC 000106A	
 	

04/92	
 	

LONGSHORE AND HARBOR WORKERS COMPENSATION ACT COVERAGE ENDORSEMENT
	

 	
 	

 	
 	
As permitted by state jurisdiction.

California approved a state-specific version. Not available in the monopolistic states other than WA.
	

WC 000109A	
 	

04/92	
 	

OUTER CONTINENTAL SHELF LANDS ACT COVERAGE ENDORSEMENT

"No such work at this time. It is agreed that if any work is subject to the Outer Continental Shelf Lands Act, the Insurer will endorse the policy within sixty (60) days of the notification."
	

WC 000111	
 	

 	
 	

MIGRANT AND SEASONAL AGRICULTURAL WORKERS PROTECTION ACT COVERAGE ENDORSEMENT
	WC 000201A	 	04/92	 	MARITIME COVERAGE

Description of work: "No such work at this time. It is agreed that if any work is subject to the Maritime Coverage Endorsement, the Insurer will endorse the policy within sixty (60) days of the notification".
	

WC 000203	
 	

04/84	
 	

VOLUNTARY COMPENSATION MARITIME COVERAGE ENDORSEMENT
	

 	
 	

 	
 	

EMPLOYEES: "All employees who are masters or members of the crew of any vessel."
 Workers Compensation Law: "State of Hire"
 DESCRIPTION OF WORK:
"No such work at this time. It is agreed that if any work is subject to the Maritime Coverage Endorsement, the Insurer will endorse the policy within sixty (60) days of the notification."
	

WC 000301	
 	

04/84	
 	

ALTERNATE EMPLOYER ENDORSEMENT (STATE APPROVED—HI, OK, AND TX)

Requires specifics name of Alternate Employer
	

WC 000301A	
 	

02/89	
 	

ALTERNATE EMPLOYER ENDORSEMENT (ALL OTHER STATES WHERE WE ARE USING A MASTER POLICY, EXCEPT AK AND CA)

19

 

	 	 	 	 	•	Requires specifics name of Alternate Employer
	 	 	 	 	•	This endorsement is not approved in Alaska.
	 	 	 	 	•	Hawaii, Oklahoma and Texas continue to use the prior version WC 000301 (4-84). California policies utilize the Labor Contractor Endorsement.
	 	 	 	 	•	The remaining states approved this endorsement.
	

WC 000302	
 	

04/84	
 	

DESIGNATED WORKPLACES EXCLUSION ENDORSEMENT
	 	 	 	 	•	California disapproved this endorsement, but uses Endorsement Agreement Limiting & Restricting This Insurance Form# 7606H for this purpose.
	 	 	 	 	•	Pennsylvania disapproved this endorsement, but uses Exclusion of Employees Endorsement WC 370303 for wrap-ups. The sponsor is named as statutory employer.
	 	 	 	 	•	Connecticut approved a state-specific version of this endorsement.
	 	 	 	 	•	The remaining states approved this endorsement.
	

WC 000310	
 	

04/84	
 	

SOLE PROPRIETOR, PARTNER, OFFICER AND OTHERS
	 	 	 	 	•	California and Texas approved a state-specific version.

This endorsement is not approved in Pennsylvania
 Partners: All partners
 Officers: All executive officers
 Others:
Each person named in Item 4 of the Information Page
	WC 000311	 	04/84	 	VOLUNTARY COMPENSATION AND EMPLOYERS LIABILITY
	 	 	 	 	 	Employees: All Officers and Employees, including any volunteers not subject to the Workers Compensation law except masters and members of the crew of any vessel.
 State
of Employment: Any state designated in Item 3.A. of the Information Page of this policy
 Compensation Law: State of Hire
	

WC 000311A	
 	

08/91	
 	

VOLUNTARY COMPENSATION AND EMPLOYERS LIABILITY
	 	 	 	 	 	Employees: All Officers and Employees, including any volunteers not subject to the Workers Compensation law except masters and members of the crew of any vessel
 State
of Employment: Any state designated in Item 3.A. of the Information Page of this policy

Compensation Law: State of Hire
	

WC 000313	
 	

04/84	
 	

WAIVER OF SUBROGATION
	 	 	 	 	•	A waiver of subrogation is not permitted in Kentucky, New Hampshire and New Jersey.
	 	 	 	 	•	California, Tennessee, Texas and Utah approved a state-specific version.
	

 	
 	

 	
 	

Schedule:
	 	 	 	 	"Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss."
	WC 60904	 	08/94	 	FOREIGN VOLUNTARY COVERAGE ENDORSEMENT

20

 

	 	 	 	 	•	Minnesota, New Jersey, North Carolina and Pennsylvania do not permit usage of this endorsement. Foreign coverage is dictated by state law.
	 	 	 	 	•	Alaska, California, Florida and Massachusetts approved a state-specific version.
	 	 	 	 	•	New York and Wisconsin require usage of a state-prescribed Bureau form.
	 	 	 	 	•	This endorsement is approved in Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, DC, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi,
Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia and Wyoming.
	

 	
 	

 	
 	

Schedule:
	 	 	 	 	Name(s) of Employee: "All officers and Employees while stationed or traveling outside of the United States of America, its territories or possessions, except masters and members of the crew of any
vessel"
	

 	
 	

 	
 	

State or Country of Operations: "Anywhere in the world, including international waters or airspace, but excluding the United States of America (including its territories and possessions) and Puerto Rico and those countries
against which the Office of Foreign Assets Control of the U.S. Department of the Treasury administers and enforces economic and trade sanctions"
 Designated Workers Compensation Law: State of
hire
 Limits of Liability for Excess Repatriation Expense:
	 	 	 	 	 	            $25,000—Each employee

            $25,000—Each accident
	 	 	 	 	Limits of Liability for Part Two-Employers Liability:
	 	 	 	 	 	            $2,000,000—Bodily Injury by Accident

            $2,000,000—Bodily Injury by Disease.

                                    [policy limit and each
employee]
	WC 990008A	 	10/03	 	AMENDMENT OF YOUR DUTIES IF INJURY OCCURS ENDORSEMENT
	 	 	 	 	•	This endorsement is approved in Alabama, Arizona, Connecticut, Delaware, DC, Hawaii, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, New Hampshire, New Mexico, Pennsylvania, Rhode
Island, South Dakota, Utah, Vermont and Virginia.
	

WC 990011A	
 	

10/03	
 	

UNINTENTIONAL ERRORS AND OMISSIONS ENDORSEMENT
	 	 	 	 	•	California continues to use the prior version WC 990011.
	

 	
 	

 	
 	

 	
This endorsement is approved in Approved in Alabama, Arizona, Connecticut, Delaware, DC, Hawaii, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, New Hampshire, New Mexico,
Pennsylvania, Rhode Island, South Dakota, Utah, Vermont and Virginia.

21

 

	

WC000420	
 	

12/02	
 	

TERRORISM RISK INSURANCE EXTENSION ACT ENDORSEMENT
	

WC000320A	
 	

02/92	
 	

LABOR CONTRACTOR ENDORSEMENT

This endorsement is used in certain states where a Multiple Coordinated Policy approach is required.
	

 	
 	

 	
 	
New York uses a state specific endorsement.
	

 	
 	

 	
 	
Florida continues to use the prior version WC000320 (4-91).
	

WC000323

And
 WC000323A (1-06)	
 	

04/84	
 	

MULTIPLE COORDINATED POLICY ENDORSEMENT

This endorsement is used in certain states where a Multiple Coordinated Policy approach is required.
	

WC000303C	
 	

10/04	
 	

EMPLOYERS LIABILITY COVERAGE ENDORSEMENT

(ATTACHED TO THE MASTER POLICY)
	

 	
 	

 	
 	
This endorsement is used to provide stop gap coverage (employers' liability). It is intended for the monopolistic states of North Dakota, Washington, West Virginia and Wyoming. It can NOT be attached to a policy which
has a deductible provision.
	

 	
 	

 	
 	
This endorsement is not available in New Jersey and Texas.
	

 	
 	

 	
 	
Ohio uses state-specific endorsement WC 34 03 01 B (4-92).
	

 	
 	

 	
 	
This endorsement is approved in Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, DC, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland,
 Massachusetts, Michigan (exempt from filing), Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota,
Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.
	

WC340301B	
 	

04/92	
 	

OHIO EMPLOYERS LIABILITY COVERAGE ENDORSEMENT—(ATTACHED TO THE MASTER POLICY)

This endorsement is used to provide stop gap coverage (employers' liability). It is intended for the monopolistic state of Ohio. It can not be attached to a policy that has a deductible provision.
	WC 53820	 	07/92	 	LARGE RISK RATING PLAN ENDORSEMENT (SHORT FORM)
	WC 990002	 	01/02	 	LOSS REIMBURSEMENT ENDORSEMENT
	WC 990905	 	10/02	 	FLORIDA LOSS REIMBURSEMENT ENDORSEMENT

	 

	CA Coverage Forms, Extensions and Exclusions

	Form #

California
 
	 	Edition Date

Non-NCCI
	 	Name
	 	 

	Various	 	 	 	All Mandatory State Endorsements
	WC 000104A	 	10/04	 	FEDERAL EMPLOYERS LIABILITY ACT COVERAGE
	WC 040101A	 	04/92	 	LONGSHORE AND HARBOR WORKERS COMPENSATION ACT COVERAGE ENDORSEMENT

22

 

	WC 000109A	 	04/92	 	OUTER CONTINENTAL SHELF LANDS ACT COVERAGE ENDORSEMENT

Description of work
	 	 	 	 	 	 	"No such work at this time. It is agreed that if any work is subject to the Outer Continental Shelf Lands Act, the Insurer will endorse the policy within sixty (60) days of the notification."
	

WC 000201A	
 	

04/92	
 	

MARITIME COVERAGE ENDORSEMENT

Description of work:
	 	 	 	 	 	 	"No such work at this time. It is agreed that if any work is subject to the Maritime Coverage Endorsement, the Insurer will endorse the policy within sixty (60) days of the notification".
	

WC 000203	
 	

04/84	
 	

VOLUNTARY COMPENSATION MARITIME COVERAGE ENDORSEMENT

EMPLOYEES: "All employees who are masters or members of the crew of any vessel."
	 	 	 	 	Workers Compensation Law: CA

DESCRIPTION OF WORK: "No such work at this time. It is agreed that if any work is subject to the Maritime Coverage Endorsement, the Insurer will endorse the policy within sixty (60) days of the notification."
	

WC 040315	
 	

09/05	
 	

CA LABOR CONTRACTOR AS NAMED INSURED WITH LCF DESIGNATION—RESTRICTION OF COVERAGE TO CLIENT WORKERS—(Replaces Alternate Employer Liability Endorsement)
	7606H	 	 	 	DESIGNATED WORKPLACES EXCLUSION ENDORSEMENT
	 	 	 	 	•	 	CA Designated Workplace Endorsement 7606H is designed to exclude locations/worksites that are part of a construction wrap up.
	 	 	 	 	•	 	This endorsement will be issued and attached when specifically requested. There is no one CA policy.
	

WC 040304	
 	

04/84	
 	

CA SOLE PROPRIETOR COVERAGE ENDORSEMENT
	 	 	 	 	 	 	Partners: All partners
 Officers: All executive officers
 Others: Each person named in
Item 4 of the Information Page
	WC 040305	 	01/85	 	CA VOLUNTARY COMPENSATION AND EMPLOYERS LIABILITY

Employees: "It is agreed that if any such person is subject to the Voluntary Compensation and Employers Liability Coverage Endorsement, the Insurer will endorse the policy within sixty (60) days of
notification".
	

WC 990422	
 	

10/05	
 	

FOREIGN VOLUNTARY COVERAGE ENDORSEMENT
	 	 	 	 	Schedule
	 	 	 	 	 	 	Name(s) of Employee: "All officers and Employees while stationed or traveling outside of the United States of America, its territories or possessions, except masters and members of the crew of
any vessel".

23

 

	

 	
 	

 	
 	

 	
 	

State or Country of Operations: "Anywhere in the world, including international waters or airspace, but excluding the United States of America (including its territories and
possessions) and Puerto Rico and Those countries against which the Office of Foreign Assets Control of the U.S. Department of the Treasury administers and enforces economic and trade sanctions".
	

 	
 	

 	
 	

 	
 	

Designated Workers Compensation Law: "California"
	

 	
 	

 	
 	

 	
 	

Limits of Liability for Excess Repatriation Expense:
 $25,000—Each employee

$25,000—Each accident
 Limits of Liability for Part Two-Employers Liability:
 $2,000,000—Bodily Injury by Accident

$2,000,000—Bodily Injury by Disease. [policy limit and each employee]
 Rates: "Included in the State of regular employment".
	

WC 040361	
 	

11/90	
 	

CA BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
	 	 	 	 	 	 	Schedule:
 "Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of
loss."
	WC 040306	 	04/84	 	CA BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
	WC 990011A	 	10/03	 	UNINTENTIONAL ERRORS AND OMISSIONS ENDORSEMENT
	WC 990017	 	01/01	 	CA CANCELLATION ENDORSEMENT
	WC 990421a	 	01-02	 	CA LOSS REIMBURSEMENT ENDORSEMENT

Defense Base Act Coverage is not provided. Premium will be quoted separately by Worldsource will be billable outside of this program.  

Workers' Compensation Premiums

Except
for guaranteed cost policies, the Workers' Compensation premium does not include the non-ratable elements mandated by the various states. 

WC/EL
premiums and non-ratable elements are subject to rates approved by the various states and the actual experience modifications promulgated. Premium adjustments resulting from WC/EL
rate/premium changes applicable at inception, which were not recognized at the time the workers' compensation policy was initially rated, will result in revised installments reflecting the amount of
any such adjustments. The revised amounts will be an obligation of yours under the insurance program. 

Workers' Compensation Loss Reimbursement (Deductible) Policy/Plan Premiums

A
discount in the premium for the loss reimbursement (deductible) policies shown in the schedule is calculated in accordance with our deductible rating plan. The premium includes a provision for
certain taxes and assessments (including residual market plan assessments), which we expect to become obligated to pay based on the premium. 

Furthermore,
in the event that any state regulatory authority determines that deductible reimbursements are taxable as premium or subject to assessments you will be obligated to pay the premium taxes
and/or assessments applicable to the Policies. 

Any
additional premium amounts calculated under this insurance program do not accrue toward maximum or aggregates which may be included in your Casualty Insurance Program. 

24

 

 

 
 

Commercial General Liability    
    

Policy
Term: Effective at 12:01
AM            1/1/2008                        to   
         1/1/2009
 

Your
Coverage Trigger ý Occurrence

	Each Occurrence Combined Single Limit	 	$	2,000,000
	Personal & Advertising Injury Limit	 	$	2,000,000
	Damage to Premises Rented to You	 	$	2,000,000
	Medical Expense Limit (any one person)	 	$	10,000
	Employee Benefits Liability*	 	$	2,000,000
	 	Subject to a Deductible of: $500,000	 	 	 
	 	ý *A Claims Made Form—Retrospective Date 06/15/1995	 	 	 
	General Aggregate Limit—Per Policy	 	$	4,000,000
	Products-Completed Operations Aggregate Limit	 	$	4,000,000

	 

	 
	 	Deductible
	 	Applicable To

	Premises, Operations, Personal and Advertising Injury, Medical Payments, or Damage to Property Liability	 	$	500,000	 	Each Occurrence
	Products-Completed Operations Liability	 	$	500,000	 	Each Occurrence

Note: 1)For Insured States, the limit of coverage as shown in this document include(s) the Deductible/Retention Limit layer amount(s) retained by the
Insured. 2) For Self-Insured States, the limits of liability shown are in excess of the Self Insured Retention amount.
3) Aggregate Limits apply where applicable.

	Coverage Extensions and Exclusions

	Form #
 
	 	Edition Date
	 	Name
 

	CG 00 01	 	12/04	 	Commercial General Liability Coverage Form (Occ.)
	IL 00 17	 	 	 	Common Policy Conditions
	

Various	
 	

 	
 	

All Mandatory State Endorsements
	

CG 2011	
 	

01/96	
 	

ADDITIONAL INSURED—MANAGERS OR LESSORS OF PREMISES
	 	 	 	 	•	NAME OF PERSON OR ORGANIZATION: ALL LESSORS WHERE REQUIRED BY CONTRACT
	CG 2015	 	07/04	 	ADDITIONAL INSURED—VENDOR
	 	 	 	 	•	VENDORS: ANY VENDOR FOR WHOM THE INSURED HAS AGREED TO PROVIDE SUCH INSURANCE UNDER CONTRACT.
	 	 	 	 	•	PRODUCTS: ALL PRODUCTS OF THE NAMED INSURED
	CG 0224	 	10/93	 	EARLIER NOTICE OF CANCELLATION PROVIDED BY US (90/10 DAYS)
	62134	 	03/95	 	WHEN WE DO NOT RENEW (90 DAYS ADVANCE NOTICE)
	CG 24 04	 	10/93	 	WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
	61712	 	12/06	 	ADDITIONAL INSURED—WHERE REQUIRED UNDER CONTRACT OR AGREEMENT

25

 

	51767	 	04/02	 	EMPLOYEE BENEFITS LIABILITY COVERAGE (CLAIMS-MADE)
	 	 	 	 	•	Alaska, Connecticut, Illinois, Maine, Missouri, New Hampshire and Pennsylvania approved a state-specific endorsement.
	

 	
 	

 	
 	

 	
The endorsement is not approved in Arkansas, Louisiana, Massachusetts, Nebraska, New Mexico, New York, North Carolina, Texas, Vermont, Virginia, Washington and Wyoming.
	

 	
 	

 	
 	

 	
The endorsement is approved in the remaining states.
	

 	
 	

 	
 	

SCHEDULE:

Each Wrongful Act or Series of Related

Wrongful Acts: $2,000,000

Aggregate: Included within General Aggregate.

Deductible: $500,000

Retro Active Date: 6/15/1995

Premium: Included
	

61707	
 	

12/94	
 	

AMENDMENT OF DUTIES IN THE EVENT OF OCCURRENCE, CLAIMS OR SUIT
	61944	 	02/95	 	BROAD FORM NAMED INSURED ENDORSEMENT
	62132	 	03/95	 	UNINTENTIONAL ERRORS AND OMISSIONS
	65324	 	11/96	 	MARITIME LIABILITY ENDORSEMENT IN REM COVERAGE
	65157	 	04/96	 	INCIDENTAL MEDICAL MALPRACTICE LIABILITY COVERAGE
	67265	 	03/97	 	AMENDMENT OF OTHER INSURANCE
	64009	 	11/95	 	NON-OWNED WATERCRAFT ENDORSEMENT
	71705	 	09/98	 	LIBERALIZATION CLAUSE
	74440	 	09/01	 	EXTENDED EXCEPTION FOR FIRE DAMAGE LIABILITY
	74435	 	09/01	 	AMENDMENT OF WHO IS AN INSURED (RECREATIONAL COVERAGE)
	67446	 	04/97	 	LIMITED JOINT VENTURE COVERAGE
	Manuscript Endorsement	 	Manuscript Endorsement	 	JOINT VENTURE ENDORSEMENT
 (endorsement #001 on policy)
	Manuscript Endorsement	 	Manuscript Endorsement	 	AMEND DEFINITION OF INSURED CONTRACT
 (endorsement #002 on policy)
	Manuscript Endorsement	 	Manuscript Endorsement	 	NOTICE OF OCCURRENCE—VICE PRESIDENT OF RISK MANAGEMENT
	 	 	 	 	Underwriters shall not deny coverage as the result of an unintentional failure by the insured to give notice as respects any occurrence, provided notice is given as soon as practicable after the Vice President of Risk
Management of Gevity HR Inc. (or equivalent) becomes aware that this policy may apply to such occurrence. (endorsement #003 on policy)
	Manuscript Endorsement	 	Manuscript Endorsement	 	AMENDATORY ENDORSEMENT—AMENDMENT OF DUTIES IN THE EVENT OF OCCURRENCE, CLAIM, SUIT OR LOSS (FORM 61707)
	 	 	 	 	Notice will be given to the Vice President of Risk Management (or equivalent) in lieu of Director of Risk Management. (endorsement #004 on policy)
	Manuscript Endorsement	 	Manuscript Endorsement	 	WHO IS AN INSURED ENDORSEMENT—ASSOCIATIONS, CLUBS OR OTHER ORGANIZATIONS AND "CORPORATE EMPLOYEE" MEMBERS.

26

 

	 	 	 	 	(endorsement #005 on policy)
	Manuscript Endorsement	 	Manuscript Endorsement	 	AMENDATORY ENDORSEMENT—AMENDMENT OF SECTION V.—DEFINITIONS—OF FORM CG 00 01 (12/04).
	 	 	 	 	Amend definition 5. "Employee" and 10. "Leased Worker" as well as add definition 23. "Client Employee". (endorsement #006 on policy).
	

 	
 	

 	
 	
It is understood and agreed that Section V—Definitions of form CG 0001 (12/04), Commercial General Liability Coverage Form of the policy is amended as
follows:
	

 	
 	

 	
 	
The Definitions of "Employee" and "Leased Worker" item 5 and 10 are deleted and replaced by the following:
	

 	
 	

 	
 	

 	

5. "Employee" includes a "leased worker" and "client employee". "Employee" does not
include a "temporary worker".
	

 	
 	

 	
 	

 	

10. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of
your business. "Leased worker" does not include a "temporary worker". As used in this policy, "Leased worker"
does not mean or include "client employees".
	

 	
 	

 	
 	
In addition, Item 23. is added to the Definition Section "Client Employee" defined as follows:
	

 	
 	

 	
 	

 	

23. "Client Employee" also known as a worksite employee means a person employed by you for the purpose of performing duties related to the conduct of your client's business or
working directly for your client under a Professional Employer Organization Services Agreement.
	 	 	 	 	(final wording of this endorsement subject to AIG legal review.)
	Manuscript Endorsement	 	Manuscript Endorsement	 	KNOWLEDGE OF AN OCCURRENCE—VICE PRESIDENT OF RISK MANAGEMENT (or equivalent) (endorsement #008 on policy)
	Manuscript Endorsement	 	Manuscript Endorsement	 	EXTENSION SCHEDULE OF NAMED INSUREDS
 (endorsement #010 on policy)
	64011	 	11/05	 	AMENDMENT OF COVERAGE TERRITORY
	65329	 	09/01	 	DELETION OF CONTRACTUAL LIABILITY EXCLUSION (COVERAGE B)
	67260	 	03/97	 	BODILY INJURY DEFINITION EXTENSION
	82540	 	04/05	 	ASBESTOS & SILICOSIS EXCLUSION
	62251	 	09/01	 	AIRCRAFT PRODUCTS EXCLUSION AND GROUNDING ENDORSEMENT
	CG 2116	 	07/98	 	EXCLUSION—DESIGNATED PROFESSIONAL SERVICES
	CG 2147	 	07/98	 	EMPLOYMENT-RELATED PRACTICES EXCLUSION
	64004	 	09/01	 	ERISA EXCLUSION
	78689	 	07/03	 	FUNGUS EXCLUSION
	CG 22 48	 	03/05	 	EXCLUSION—INSURANCE AND RELATED OPERATIONS
	58332	 	07/93	 	LEAD LIABILITY EXCLUSION
	IL 0021	 	07/02	 	NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM)
	 	 	 	 	•	New York approved IL 0023.
	 	 	 	 	•	The 11-85 edition is approved in Virginia.

27

 

	 	 	 	 	•	The 5-02 edition is approved in Nebraska.
	 	 	 	 	•	The 6-02 edition is approved in Vermont.
	 	 	 	 	•	The 5-04 edition is approved in Texas.
	 	 	 	 	•	The remaining states approved the 7-02 edition
	

62898	
 	

09/01	
 	

RADIOACTIVE MATTER EXCLUSION
	87295	 	01/05	 	Exclusion—Violation of Statutes in Connection with Sending, Transmitting or Communicating Any Material or Information (CAN-SPAM Act)
	89644	 	07/05	 	Coverage Territory Endorsement (OFAC)
	81461	 	08/04	 	LARGE RISK RATING PLAN ENDORSEMENT
	 	 	 	 	POLICY NUMBER: T B A
	71709	 	03/04	 	COMPOSITE RATING PLAN PREMIUM ENDORSEMENT
	Manuscript Endorsement	 	Manuscript Endorsement	 	NAMED PERIL/TIME ELEMENT POLLUTION COVERAGE (AIG FORM PREVIOUSLY PROVIDED.)
	73187	 	09/03	 	DEDUCTIBLE COVERAGE ENDORSEMENT—A
	Manuscript Endorsement	 	Manuscript Endorsement	 	AMENDMENT OF "WHO IS AN INSURED" TO QUALIFY THAT "CLIENT INSUREDS ARE NOT INSUREDS UNDER THE CGL COVERAGE.
	

 	
 	

 	
 	
(final wording of this endorsement subject to AIG legal review.)

NOTES ON SPECIAL COVERAGE(S)  

28

 

 

 
 

Commercial Automobile Liability    
    

Policy
Term: Effective at 12:01
AM            1/1/2008                        to   
         1/1/2009
 

	Coverage
 
	 	Coverage

Symbols
	 	Limits

	Combined Single Limit—	 	1	 	$2,000,000
	Personal Injury Protection—(Per Insured's Selection)	 	N/A	 	N/A
	Medical Payments—Each Person Insured—	 	N/A	 	N/A
	Uninsured Motorists/Underinsured Motorists—

(Per Insured's Selection)*

*Not Available in Indiana, Ohio or Michigan	 	10	 	Options: (check applicable option):

ý 1.) Rejection where possible/minimum limits elsewhere

o 2.) Policy limits where possible/maximum limits elsewhere

o 3.) Other limits (identify limit(s))

$

	 

	 
	 	Deductible
	 	Applicable To

	Automobile Liability, Including UM/UIM/PIP, If Any	 	$	500,000	 	Each Accident

Note: 1)For Insured States, the limit of coverage as shown in this document include(s) the Deductible/Retention Limit layer amount(s) retained by the
Insured. 2) For Self-Insured States, the limits of liability shown are in excess of the Self Insured Retention amount.
3) Aggregate Limits apply where applicable.

	Coverage Extensions and Exclusions

	Form #
 
	 	Edition Date
	 	Name
 

	CA 00 01	 	03/06	 	Business Auto Coverage Form
	IL 00 17	 	 	 	Common Policy Conditions
	

Various	
 	

 	
 	

All Mandatory State Endorsements
	

CA 2001	
 	

03/06	
 	

LESSOR—ADDITIONAL INSURED AND LOSS PAYEE

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Kansas and Texas.
	 	 	 	 	•	Hawaii, Massachusetts and Virginia use a state-specific endorsement.
	 	 	 	 	•	The 10-01 edition is approved AK, CT, GA, LA, NH, NY and OR.
	 	 	 	 	•	The 3-06 edition is approved in the remaining states.
	

 	
 	

 	
 	
DESCRIPTION: ALL LEASED AUTOS
	61944	 	02/95	 	BROAD FORM NAMED INSURED

STATE APPROVALS:
	 	 	 	 	•	Texas approved a state-specific version of this endorsement.
	 	 	 	 	•	This endorsement is not approved in Arkansas, Delaware, Idaho, Massachusetts, Nebraska, North Carolina, Ohio, Vermont and Virginia.
	 	 	 	 	•	The endorsement is approved in the remaining states.

29

 

	

CA 2313	
 	

12/93	
 	

TRAILER INTERCHANGE FIRE AND FIRE AND THEFT COVERAGES

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Texas.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	

 	
 	

 	
 	
Limit of Insurance: $2,000,000

Rate: Flat

Minimum Premium: Included
	

CA 9910	
 	

09/02	
 	

DRIVE OTHER CAR COVERAGE—BROADENED COVERAGE FOR NAMED INDIVIDUALS

STATE APPROVALS:
	 	 	 	 	•	California, Massachusetts, Texas and Virginia approved a state-specific version of this endorsement.
	

 	
 	

 	
 	

•	
The endorsement is approved in the remaining states.
	

 	
 	

 	
 	

Name of Individual: "All executives of the named insured who are furnished autos by the Named Insured and who do not have personal auto insurance"
	

CA 9916	
 	

12/93	
 	

HIRED AUTOS SPECIFIED AS COVERED AUTOS YOU OWN

STATE APPROVALS:
	 	 	 	 	•	Hawaii and Texas approved a state-specific version of this endorsement.
	 	 	 	 	•	This endorsement is not approved in Kansas.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	

 	
 	

 	
 	

Description of Auto:
 "Any auto hired, loaned, leased or furnished to the Named Insured for a period of six (6) months or more".
	

CA 9933	
 	

02/99	
 	

EMPLOYEES AS INSUREDS

STATE APPROVALS:
	 	 	 	 	•	Texas approved a state-specific version of this endorsement.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	

CA 9954	
 	

07/97	
 	

COVERED AUTO DESIGNATION SYMBOL

STATE APPROVALS:

This endorsement is approved in all states.
	

 	
 	

 	
 	

Description:

Symbol 10 = "Hired autos" and/or "non-owned autos" where there is a statutory requirement to provide Uninsured Motorists or Underinsured Motorists coverage when liability coverage is provided, unless the insured has rejected such
coverage.
	

CA 2054	
 	

10/01	
 	

EMPLOYEE HIRED AUTOS

STATE APPROVALS:
	 	 	 	 	•	Louisiana approved a state-specific version of this endorsement.

30

 

	 	 	 	 	•	The endorsement is approved in the remaining states.
	61709	 	12/94	 	AMENDMENT OF DUTIES IN THE EVENT OF ACCIDENT, CLAIMS, SUIT OR LOSS

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Arkansas, North Carolina, Ohio and Virginia.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	

87950	
 	

10/05	
 	

ADDITIONAL INSURED—WHERE REQUIRED UNDER CONTRACT OR AGREEMENT

STATE APPROVALS:
	 	 	 	 	•	The 10/05 version has been approved in all states other than VA.
	 	 	 	 	•	New York approved a state-specific version of this endorsement 94199 (3/07).
	

 	
 	

 	
 	
Schedule of Additional Insureds: "Any person or organization for whom you are contractually bound to provide Additional Insured status but only to the extent of such person or organizations
liability arising out of the use of a covered "auto".
	

62135	
 	

03/95	
 	

WHEN WE DO NOT RENEW

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Arkansas, Delaware, Idaho, Massachusetts, Michigan, Nebraska, New Hampshire, North Carolina, South Carolina, Vermont, Virginia and Washington.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	62138	 	03/95	 	EARLY NOTICE OF CANCELLATION PROVIDED BY US

(90 Days for Non-Renewal and 10 days for Non-Payment

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Arkansas, Delaware, Idaho, Massachusetts, Michigan, Nebraska, New Hampshire, North Carolina, South Dakota and Vermont.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	

62897	
 	

06/95	
 	

WAIVER OR TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Arkansas, North Carolina and Ohio.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	65330	 	11/96	 	MEXICAN COVERAGE BROAD FORM

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Texas and Virginia.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	67264	 	03/97	 	EXPECTED OR INTENDED INJURY EXCLUSION AMENDMENT (REASONABLE FORCE EXCEPTION)

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Minnesota and Texas.

31

 

	 	 	 	 	•	The endorsement is approved in the remaining states.
	74438	 	10/99	 	BODILY INJURY DEFINITION EXTENSION

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in Idaho, Maine, Michigan, Mississippi, South Dakota, Virginia, West Virginia and Wisconsin.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	

86679	
 	

08/04	
 	

FELLOW EMPLOYEE EXCLUSION DELETED
 Note: This endorsement previously had form number 64007 (11-95). Since there is a GL form with the same number, we had to assign a new form number to this endorsement. It is now
86679.
 STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved Maryland, New Jersey, Virginia and Wisconsin.
	 	 	 	 	•	The endorsement is approved in the remaining states.
	MCS—90	 	04/00	 	MOTOR CARRIER PUBLIC LIABILITY ENDORSEMENT (MCS-90)
	IL 0021	 	07/02	 	NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM)

STATE APPROVALS:
	 	 	 	 	•	This endorsement is not approved in New York.
	 	 	 	 	•	Washington uses IL 01 98 7-02.
	 	 	 	 	•	The 3-92 edition is approved on Texas.
	 	 	 	 	•	The 4-98 edition is approved in Massachusetts.
	 	 	 	 	•	The 5-02 edition is approved in Nebraska.
	 	 	 	 	•	The 6-02 edition is approved in Vermont.
	 	 	 	 	•	The remaining states approved the 7-02 edition.
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	AMEND DEFINITION OF INSURED CONTRACT
 (endorsement #1 on the policy)
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	AMENDATORY ENDORSEMENT—AMEND SECTION V.—DEFINITIONS—OF FORM CA 00 01 (03/06).
 Amend definition F. "Employee" and I. "Leased Worker" as well as add definition Q. "Client
Employee". (endorsement #2 on policy).
	

 	
 	

 	
 	
It is understood and agreed that Section V—Definitions of form CA 0001 (03/06), Business Auto Coverage Form of the policy is amended as follows:
	

 	
 	

 	
 	
The Definitions of "Employee" and "Leased Worker" are deleted and replaced by the following:
	

 	
 	

 	
 	

 	

F. "Employee" includes a "leased worker". "Employee" does not include

        a "temporary worker" or a "client employee".

32

 

	

 	
 	

 	
 	

 	

I. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased
worker" does not include a "temporary worker". As used in this policy, "Leased worker" does not mean or include "client
employees".
	

 	
 	

 	
 	
In addition, Item Q. is added to the definition section "Client Employee" defined as follows:
	

 	
 	

 	
 	

 	

Q. "Client Employee", also known as a worksite employee, means a person employed by you for the purpose of performing duties related to the conduct of your client's business or working directly for your client under a
Professional Employer Organization Services Agreement.
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	NOTICE OF ACCIDENT
 The Company shall not deny coverage as the result of an unintentional failure by the insured to give notice as respects to any accident, provided notice is given as soon as
practicable after the Vice President of Risk Management (or equivalent) becomes aware that this policy may apply to such accident. (endorsement #3 on the policy)
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	KNOWLEDGE OF OCCURRENCE
 It is understood and agreed that knowledge of an occurrence, claim or suit by any agent, servant or employee of the insured shall not constitute knowledge by the
insured unless the Vice President of Risk Management & Insurance of the GEVITY HR, Inc. (or equivalent) has received such notice. (endorsement #4 on the policy)
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	AMENDATORY ENDORSEMENT—AMENDMENT OF DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS (FORM 61709)
 Notice will be given to the Vice President of Risk Management (or equivalent) in lieu
of Corporate Risk Manager. (endorsement #5 on the policy)
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	AMENDATORY ENDORSEMENT
 It is hereby agreed that Employees as Insureds Endorsement (CA9933) and Employee Hired Autos Endorsement (CA2054) does not apply to "client employees". (endorsement #6
on the policy)
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	UNINTENTIONAL ERRORS AND OMISSIONS ENDORSEMENT
 Section IV—Business Automobile Conditions—Representations is added. (endorsement #8 on the policy)
	MANUSCRIPT ENDORSEMENT	 	MANUSCRIPT ENDORSEMENT	 	EXTENSION SCHEDULE OF NAMED INSUREDS
 (endorsement #10 on the policy)
	53820	 	07/92	 	LRRP SHORT FORM ENDORSEMENT

POLICY NUMBER: T B A
	73187	 	09/03	 	DEDUCTIBLE COVERAGE ENDORSEMENT—A

33

 

	89644	 	07/05	 	COVERAGE TERRITORY ENDORSEMENT (O.F.A.C.)

STATE APPROVALS:
	 	 	 	 	•	This endorsement is disapproved in Virginia.
	 	 	 	 	•	The endorsement is approved in the remaining states.

NOTES ON SPECIAL COVERAGE(S): AIG WILL REVIEW AUTOMOBILE COVERAGES TO CONFIRM THAT HANDLING AND WORDING OF CLIENT EMPLOYEE EXPOSURES ARE IN LINE WITH HANDLING ON
CGL.

UM/UIM Automobile Coverage

For
Uninsured Motorists coverage (UM), Underinsured Motorist coverage (UIM) and Personal Injury Protection coverage (PIP), there are specific rejection/election of coverage forms that must be
completed, signed, and returned to us prior to the inception of automobile coverage. You must complete, sign and return such forms to us by the Policy(ies) inception date of coverage. Your failure to
return all required selection forms shall be deemed your acceptance that the automobile policy(ies) will be issued and rated to include the limits of UM/UIM coverage equal to the policy limits of
liability, or equal to the maximum limits required by law if lower than policy limits, and the limit for PIP coverage that we are required to offer for each state. In the event you fail to return the
signed forms and we apply UM/UIM and PIP limits as described herein an additional charge for this change in coverage will be added to your Automobile Liability premium, as referenced in
Section 2., Program Rates and Premiums. Your acceptance of the casualty insurance program supersedes anything to the contrary in specification(s), Binder(s), quotation(s), this binder(s) or any
other "agreement" or "understanding", and you will be responsible for the payment of UM/UIM/PIP damages within your "retention or deductible" whichever is applicable. 

Please
be advised that we do not offer UM/UIM coverage in Indiana, Michigan and Ohio. This program does not include in its pricing UM/UIM for vehicles garaged in Indiana, Michigan or Ohio. 

In
any State permitting election of UM limit "stacking", any UM coverage contemplated herein is predicated upon rejection of the  "stacking" provision by each
Named Insured. 

State DMV Proof of Coverage Reporting Requirements

The
department of Motor Vehicles (DMV) in various states has implemented anti-fraud systems that require that proof of coverage be on file in their data bases. These various state DMV's
presently mandate the filing of specific data elements as State law(s) require. These data elements must be supplied to us upon binding Automobile
Liability Coverage. Without the information, we are unable to make our mandatory reports to the DMV. It is critical that you provide information in a timely manner to your broker. If we are unable to
comply with the reporting requirements, it may result in loss of your tags, fines, impoundment of your vehicle(s), including cargo, and your inability to register your vehicle(s). In addition, you may
be subject to State fines and penalties. 

34

 

 

We have advised your broker as to the Automobile Liability Insurance Reporting Procedures information available on our web site. Additionally, we have advised your broker on how to retrieve
"templates" on our web site for capture and transmission of vehicle information for such reporting. 

For
more about the DMV reporting requirements visit the Virtual Office web site under https://www.accessaig.com/accessaig/public/home. 

It
is your responsibility to supply us, through your broker, with all of the required data on changes to your list of vehicles that are covered by the policy (vehicle list) after the inception date of
the policy. Failure to do so may result in the previously mentioned consequences. 

Please
contact your broker to ensure that all of the necessary information has been, and continues to be, provided to us. 

Automobile Coverage where a Composite Rate Applies  

For
automobile coverage, the earned premium will be computed based on the number of units at inception of the casualty insurance program plus the number of units at expiration, divided by two (2). 

 
 

COMMERCIAL AUTOMOBILE TERRORISM RISK EXTENSION ACT OF 2005 NOTIFICATION    
    

You
are hereby notified that under the Terrorism Risk Insurance Extension Act of 2005 (which amends the Terrorism Risk Insurance Act of 2002), Commercial Automobile is excluded from the covered lines
of the Act. While no federal backstop currently exists for Commercial Automobile, we are willing to provide you with Terrorism coverage subject to the limitations and exclusions of each automobile
insurance contract for the additional premium indicated below. 

For
your convenience, our standard terrorism definition follows, however, the definition may vary based on modifications required by individual state regulatory offices. 

DEFINITIONS—The
following definitions shall apply: 

"Terrorism"
means the use or threatened use of force or violence against person or property, or commission of an act dangerous to human life or property, or commission of an act that interferes with
or disrupts an electronic or communication system, undertaken by any person or group, whether or not acting on behalf of or in any connection with any organization, government, power, authority or
military force, when the effect is to intimidate, coerce or harm: 

	a.
	A
government;

	b.
	The
civilian population of a country, state or community; or

	c.
	To
disrupt the economy of a country, state or community. 

This
quotation for Commercial Automobile includes a charge for Terrorism coverage, which is referenced in Section 2. Program Rates and Premiums. 

Your responsibility for the payment of "Allocated Loss Adjustment Expenses" For Loss Sensitive

Programs/Plan is:  

	Coverage
 
	 	ALAE Option (enter ALAE Option A, B, C or D as applicable)
	 	If ALAE Option C, enter Excess %

	Worker's Compensation	 	C	 	100%
	General Liability	 	C	 	100%
	Automobile Liability	 	C	 	100%

35

 

	A:
	100%
of the total "Allocated Loss Adjustment Expenses" up to the "Retained Limit". However, the most you are responsible for with respect to damages and/or indemnity and "Allocated
Loss Adjustment Expenses" combined shall not exceed the "Retained Limit".

	B:
	100%
of the total "Allocated Loss Adjustment Expenses".

	C:
	All
or part of the "Allocated Loss Adjustment Expenses" determined according to the following: 

If
we incur NO obligation under the policy(ies) to pay damages resulting from a claim, you are responsible for all "Allocated Loss Adjustment Expenses" up to the applicable "Retained Limit" plus a
percentage of all remaining "Allocated Loss Adjustment Expenses" in excess thereof. That percentage is shown above under "Option C Excess %"; or. 

If
we DO incur an obligation under the policy(ies) to pay damages resulting from a claim, you will be responsible for a percentage of "Allocated Expense Adjustment Expenses". That percentage shall be
determined by dividing the "Retained Limit" paid by the total damages paid subject to the Limits of Insurance. 

	D:
	No
"Allocated Loss Adjustment Expenses". 

36

 

 

SECTION 4—PREMIUM PAYMENTS AND PROGRAM TERMS  

Cash
Deposit, Installments and Estimated Deferred Amounts $1,000,000 option 

	Payment No.
 
	 	Due Date
	 	Provision for

Expenses and

Excess Losses(1)
	 	Special

Taxes and

Surcharges
	 	Provision for

Limited Losses

(RCAMP)(2)
	 	Provision for

Limited Losses

(WI, WY FCR

Losses in

Premium)(2)
	 	Provision for

Limited Losses

(AL/GL)(2)
	 	Estimated

Payment

Obligation

	1	 	1/1/2008	 	$	1,272,444	 	$	463,519	 	$	4,619,353	 	$	77,773	 	$	0	 	$	6,433,089
	2	 	2/1/2008	 	$	1,350,217	 	 	 	 	$	4,619,353	 	 	 	 	$	0	 	$	5,969,570
	3	 	3/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,353	 	 	 	 	$	0	 	$	5,969,569
	4	 	4/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	5	 	5/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	6	 	6/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	7	 	7/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	8	 	8/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	9	 	9/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	10	 	10/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	11	 	11/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	12	 	12/1/2008	 	$	1,350,216	 	 	 	 	$	4,619,352	 	 	 	 	$	0	 	$	5,969,568
	Subtotals	 	$	16,124,821	 	$	463,519	 	$	55,432,227	 	$	77,773	 	$	0	 	$	72,098,340
	DLP*	 	 	N/A	 	 	N/A	 	$	0	 	$	0	 	$	600,000	 	$	600,000
	DEP*	 	$	0	 	$	0	 	 	N/A	 	 	N/A	 	 	 	 	$	0
	Totals	 	$	16,124,821	 	$	463,519	 	$	55,432,227	 	$	77,773	 	$	600,000	 	$	72,698,340

DLP
means "Deferred Loss Provision". This is the estimated amount You must pay us as "Additional Payments" described below. 

DEP
means "Deferred Expense Provision". This is an estimated amount that You must pay us as such shown in the Schedule of Policies and Premiums to the
Payment Agreement. 

Notes:
(1) "Provision for Expenses and Excess Losses" is a part of the Premium. The remainder of the Premium is included under "Provision for Limited Losses". 2) "Provision for Limited
Losses" includes provision for Loss within your Retention (both Deductible and Loss Reimbursement Limit)
and Your share of ALAE. Any "Deposit" in this column is the Claims Payment Deposit. Refer to definitions
in the Payment Agreement. 

 
 

Additional Payments    
    

You
must pay us the installment amounts by the due dates as specified in this document. We have calculated the part of those installments designated as "Provision for Limited Losses" to equal the
Losses within Your retention/deductible/loss reimbursement limit and Your share of ALAE that we expect to incur during the period for which Provision for Limited Losses amounts are shown. The amount
we incur will be the sum of the amounts we pay and the amounts we reserve for payment on claims that have been reported to us, but shall not include our reserves for losses that have been incurred but
have not been reported to us. 

 
 

Billing Method    
    

Billing to:  

ý 
You at Your address shown in the  Schedule, or 

37

 
 
 

Incurred Loss Accounting Adjustments    
    

The
first Premium Plan Adjustment will take place as soon as practicable after the expiration date of the policies. The adjustment will be based on the rates shown in this document, audited exposures
and loss information valued as of 6/30/2009 subject to the minimums indicated within the terms of your insurance program. Thereafter, annual Ultimate Incurred Loss Plan adjustments will take place and
continue until you and we agree in writing to perform no further recalculation. 

Additional
premium due us, or return premium due you, resulting from the adjustment, will be payable in its entirety within the time permitted by notice to you and subject to the terms of the Payment
Agreement. 

NOTE THAT:  

We
may apply a different table of LDF's that will enable us more accurately to estimate such final amount of Loss and  ALAE, if during the term of the policies,
 a change occurs in the hazards insured against because of Your
acquisition or disposition of a subsidiary, division or operation with assets at least equal to 20% of your assets on the effective date hereof, or the
organization that provides claims service under the Policies is changed, or Your retention/deductible/loss reimbursement
limit under any of the Policies, or any other change occurs which is likely to render the LDF's shown in the Grid ineffective as
a tool for estimating with reasonable accuracy the amount of Loss and ALAE that we will pay because of
accidents, occurrences, or offenses covered by the Policies.

SECTION 5—IMPORTANT NOTES  

 
  Documentation    
    

By
accepting this Casualty Insurance Program, the Insured agrees to provide AIG Risk Management with the correctly completed and signed documents as requested by AIG Risk Management: 

	•
	For
Loss Sensitive Programs/Plans, the Payment Agreement, including any Addendum(s), and Security required under any Premium Deferral Plan (when required), within
30 days of the inception date of the program. 

Please Note: The Payment Agreement, together with all schedules, addenda, policies and any related agreements between you and us, constitutes the basis for a program of
insurance coverage. We would not have entered into any of them without your agreement on all of them. For that reason, you should review all such documents together when making any accounting, tax or
legal determinations relating to the insurance program.  

	•
	Completed
UM/UIM/PIP Automobile Election/Rejection forms prior to inception of automobile coverage.

	•
	Per
Florida statute, an Acord 130 application applying to Workers' Compensation coverage, fully completed, executed and
notarized (applicable only to Florida coverage). AIG acknowledges that the form is completed and is not needed for 2008 renewal.

	•
	A
signed copy of the Acknowledgement form included in this document, which confirms acceptance of all aspects of the Casualty Insurance Program by the Insured and Agent,  returned within 30 days of the inception date of the
program. 

All
documents requiring signature must be signed by a authorized representative of the Insured and in some instances, on behalf of Your Insurance
Representative. All documents must be dated as of the inception date of the program. 

Failure
to execute any of the requisite documents within the time periods required will render the Financial Plan of your Casualty Insurance Program voidable at the discretion of AIG Risk 

38

 

Management.
The entire amount of the "Estimated Cost" specified under the program will thereafter become immediately due and payable to us in cash. Failure to pay premium
within 5 Days of the billing date may result in the exercise of various default remedies including, but not limited to, cancellation. 

 
 

Acquisitions and Divestitures    
    

With
respect to any acquisitions or divestitures that represent a greater than 10% increase in exposure, AIG Risk Management may, at its discretion, require a program review. That review MAY result in
a premium adjustment. 

 
 

Estimated Premium Quoted in This Binder or Binder    
    

The
estimated premium(s) shown in this Binder or Binder is based on rates, and experience modifications (if applicable) in use at the time this Binder is submitted to you. Any reference to Total or
Final Premium is for explanatory purposes only. None of the numbers herein are intended to represent final calculation. Neither AIG Global Risk Management, nor any member company of American
International, Inc. shall be bound by the calculations arrived at in the tables shown. The tables serve merely to demonstrate the calculation process. All amounts are subject to modification
through the binding process and to program adjustments after binding. The terms of the Casualty Insurance Program, our manuals of rules, classifications, rates and rating plan will determine the
adjusted premium and surcharges (if any). All information required to conduct our adjustments are subject to verification and change. 

 
 

Estimated Taxes and Assessments Quoted in this Binder For Loss Sensitive Programs/Plans    
    

Any
references made in this Binder to taxes or tax rates or assessments are subject to change if such taxes or tax rates or assessments are changed or modified by the respective taxing authority(ies)
prior to inception or following inception. You shall be obligated for any resulting increase that occurs. 

 
 

Premium Tax on Deductibles For Loss Sensitive Programs/Plans    
    

If
any state regulatory authority that mandates amounts which you have paid as deductible reimbursements are considered premium, and thus are subject to premium taxes and/or assessments makes any
claim, we will notify you of the existence of such a claim. We will give you the opportunity of joining with us in any proceeding to contest such claim at your own expense, or to contest such claim
independently at your own expense. In the event a determination is made that said reimbursed amounts are taxable as premium or subject to assessments, you will be responsible to pay the premium taxes
and/or assessments and any related fines, penalties or interest that may be imposed as a result of the non-payment of premium taxes and/or assessments applicable to the Policies. 

 
 

Notice about the Office of Foreign Assets Control (OFAC)    
    

This
Binder or resulting binder, the continuation of any bound insurance, and any payments to you, to a claimant or to another third party, may be affected by the administration and enforcement of U.
S. economic embargoes and trade sanctions by the Office of Foreign Assets Control (OFAC), if we determine that any such party is on the "Specially Designated Nationals or Blocked Persons" list
maintained by OFAC. 

 
 

Notice Applicable to Policies Issued Using the New York Trade Zone    
    

For
policies issued using the New York Trade Zone rule, the policy forms and the applicable rates are exempt from the filing requirements of the New York State Insurance Department. However, such
forms and rates must meet the minimum standards of the New York Insurance Department. 

39

 
 
 

Vermont Statute, Title 18: Health, Chapter 38: Lead Poisoning    
    

Affidavit
Attesting To Compliance With §1759. Essential Maintenance Practices 

In
1996, the State of Vermont passed legislation (Act 165) pertaining to lead poisoning. The Act requires owners of pre-1978 rental dwellings or apartments, and operators of child care
facilities housed in buildings constructed prior to 1978, to perform ESSENTIAL MAINTENANCE PRACTICES (EMP's) unless the property is certified pursuant to Act 165 to be lead-free. 

An
important part of §1759 addressing EMP's requires an owner/landlord to sign an affidavit indicating essential maintenance practices have been performed, the dates they were completed,
and who performed them. This affidavit attesting to compliance must be filed annually with us (as your liability insurance carrier) as well as the
Vermont Department of Health. 

The
member companies of American International Group, Inc., in accordance with instructions by the Vermont Department of Banking, Insurance, Securities and Health Care Administration, is
reaffirming with owners/landlords of affected properties their obligations for compliance with Act 165. If §1759 is applicable to you, your affidavit is an important component of
our underwriting
file. Compliance with the Essential Maintenance Practices, and receipt of certification from a licensed inspector, provides the owner/landlord with certain liability protections. 

Please
ensure you follow through with certification and provide us with the required affidavit so that you enjoy the full protection the statute provides. 

40

 

 

NOTE: This notice is not intended to detail the provisions of Act 165. Please see full text of the section of Act 165 (§1759) addressing EMP's on the internet at
URL:

http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=18&Chapter=038&Section=01759  

 
  Terrorism Risk Insurance Act Of 2002 And Terrorism Risk Insurance Extension Act Of 2005    
    

You
are hereby notified that under the federal Terrorism Risk Insurance Act of 2002 (the "Act") effective November 26, 2002, and its amendment, the Terrorism Risk Insurance Extension Act of
2005 (jointly referred to as the "Act"), you now have a right to purchase insurance coverage for General Liability losses arising out of an Act of Terrorism, which is defined in the Act as an act
certified by the Secretary of the Treasury (i) to be an act of terrorism, (ii) to be a violent act or an act that is dangerous to (A) human life; (B) property or
(C) infrastructure, (iii) to have resulted in damage within the United States, or outside of the United States in case of an air carrier or vessel or the premises of a U.S. mission and
(iv) to have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United
States or to influence the policy or affect the conduct of the United States Government by coercion. 

On
workers' compensation policies, coverage for acts of terrorism is mandatory and your quotation will automatically include a charge for terrorism coverage. 

You
should read the Act for a complete description of its coverage. The Secretary's decision to certify or not to certify an event as an Act of Terrorism and thus covered by this law is final and not
subject to review. There is a $100 billion dollar annual cap on all losses resulting from Acts of Terrorism above which no coverage will be provided under this policy and under the Act unless
Congress makes some other determination. 

For
your information, coverage provided under this Binder or binder for losses caused by an Act of Terrorism may be partially reimbursed by the United States under a formula established by the Act.
Under this formula the United States pays 90% of terrorism losses covered by this law exceeding a statutorily established deductible that must be met by the insurer, and which deductible is based on a
percentage of the insurer's direct earned premiums for the year preceding the Act of Terrorism. 

 
 

Payment of Premium    
    

Wire Transfers:  

The
Insured will be sent a premium invoice and the insured will then wire transfer the money, indicating what the payment is for, to our account: 

CHASE
MANHATTAN BANK, NEW YORK, N. Y.

ABA NO. 021-000-021

ACCOUNT NAME: NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA.

ACCOUNT NO. 323-160-387 Phone #: 1-877-204-1124 

The
insured is to notify AIG Risk Management the day the wire transfer is made so that we may notify our New York accounting department. 

Express Mail:  

Premium
Payments can be express mailed to the following address: 

AMERICAN
INTERNATIONAL COMPANIES

4 CHASE METROTECH CENTER, 7TH FLOOR EAST

LOCKBOX 10472

BROOKLYN, N. Y. 11245 

41

 
 
 

Premium Audit    
    

Premium
audits are required in all states covered under your Casualty Insurance Program. AIG Risk Management has a staff devoted to the professional auditing of our accounts. An auditor will be
available to meet with you to set the parameters and timetable for the audit process. Records for audit purposes should be available at each location within 30 Days after the policy(ies) anniversary
or expiration. 

Any
premium adjustment developed in the course of an audit of programs/plans that are subject to the terms of the Payment Agreement will be deferred until Plan Adjustment. Changes in the premium
amount, based on the completed audits, of all other types of program/plans, including Guaranteed cost programs, will be due within 30 Days of the billing date. 

SECTION 6—ATTACHMENTS  

  

 
 

Overview    
    

AIG
Domestic Claims, Inc. (AIGDS) is dedicated to enhancing our customers' competitive position by delivering effective risk control and claim management services which measurably reduce the
ultimate cost of risk. We are committed to excellence, responsible stewardship and superior performance. Some 2,400 claim professionals manage workers' compensation and property and casualty claims in
our service centers strategically located throughout the country. 

 
 

Special Account Instructions    
    

Where
applicable, during AIGDS' initial set up meeting we develop Special Account Instructions, with your input, to provide information to claim specialists regarding the custom claim management,
reporting and threshold requirements you need. Change requests may be submitted by the broker or customer to the AIGDS Team Representative. All service centers managing claims will be trained on these
Special Account Instructions. 

The
Special Account Instructions that are developed and tailored for you are communicated electronically with all updates immediately available through the system to our service centers. Our claim
specialists view the Special Account Instructions prior to the handling of any claim. 

 
 

Claims Reporting    
    

Reporting
claims by telephone—AIG Early Notice® (AIG EN) is a toll-free claims reporting service which allows customers to report workers' compensation, general
liability, automobile, and property claims by telephone 24 hours a day, 7 days a week. There is no cost for this service. 

Internet
Claim Reporting—AIGDS offers its customers IntelliRisk® First Notice of Loss (FNL) reporting through the Internet. This service is available to all of AIGDS' active
customers who have registered for Internet claim reporting through their service representative. For further details visit our Website at www.aigcs.net. 

 
 

Risk Management Information Systems (RMIS)    
    

Our
Risk Management Information Services (RMIS) Division provides a valuable source of claim information solutions for today's demanding risk management concerns. Through our suite of 

42

 

IntelliRisk®
e-Services and the support of our designated business and technology professionals, we help the policyholders of AIG member companies manage their claim program
and reduce costs. 

The
suite of IntelliRisk e-Services was designed to help facilitate every step of the claim process, and includes: 

IntelliRisk
NetSource®—An Internet-based online claim analysis and reporting system that provides real-time claim, payment and adjuster activity information for
companies of all types and sizes. Available features include: 

	•
	A
powerful query function to pinpoint and analyze claim information

	•
	Profiling
to identify potential high severity claims

	•
	A
communication feature to facilitate e-mail correspondence

	•
	An
online reporting tool that draws on current and historical claim data 

IntelliRisk
NetData®—Offers various methods of receiving electronic reports and data. Features include an Internet e-mail service that "pushes" an electronic
version of our loss report as a file attachment in an e-mail, reports on CD-ROM, and the ability to send data via FTP (File Transfer Protocol) and on tape, cartridge or
diskette. 

IntelliRisk®
First Notice of Loss (FNL)—Allows customers to report workers' compensation and Property and Casualty claims online, sending the information directly into the
AIGDS claim system and to the appropriate AIGDS service center. 

IntelliRisk®
Medical Provider Listing (MPL)—Provides easy, fully searchable web-access to information on nearby network doctors, hospitals or specialists. 

43

 

 

SECTION 6—ATTACHMENTS  

  

 
 

Executive Summary    
    

AIG
Consultants, Inc.®, (AIGC), a member company of American International Group, Inc., provides comprehensive safety, healthcare, environmental, property, and crisis
management services. AIGC has been providing clients with quality service for over two decades. Quality and measurable results: these factors make the difference for AIGC's customers. AIGC is
ISO 9001-2000 certified, a distinction which guarantees our organization adheres to a recognized global framework for delivering excellence in customer service, best practices and
business leadership. At the core of our operating philosophy is a commitment to delivering the highest level of professional service. Drawing on our expertise, we provide customized assistance focused
on our customers' needs. Through our international network of operations, we offer our services worldwide, and have built a record of success in effectively servicing the needs of our customers. Our
international team of over 400 consultants, supplemented by our network of qualified and approved subcontractors/vendors provide technical expertise in a wide array of specialties to ensure your
specific needs are met and sound business solutions are delivered. 

AIGC
constantly strives to add value to our consulting services by offering specialty programs designed to meet our customers' needs above and beyond the traditional offerings. Innovative programs
include: 

PATROLTM
(Planning And Tracking Response On-Line)

Threat and Vulnerability Risk Assessment (TVRA)

AIG Caring Advantage

PIER (Pollution Incident and Environmental Response) Program

Best Practices Assessments (BPA)

AIG RISK TOOL 

Our
services are consultative in nature and focus on loss drivers and your specific needs. The following key planning elements are offered for your review and consideration: 

	•
	A
single Account Manager assigned to your account providing you a single point of contact for all services provided by AIGC.

	•
	Safety
training and safety materials (programs, videos, etc.) in Spanish and English can be provided.

	•
	Additional
key services can also be utilized as required to provide business solutions to issues of most concern to our customers in today's challenging society. Such areas
as; Industrial Hygiene/Occupational Health, Safety Accountability and Incentive Programs, Behavioral Based Safety, Ergonomics, Fleet Training (on-line and personalized), and Early Return
to Work Programs.

	•
	Web
based and on-site fleet safety programs, evaluations and specialized training programs.

	•
	Development
of customized video and web based training and informational programs. 

NOTE: Basic risk control services for underwriting purposes have been included in your program. Additional risk control services are available by
contacting your AIGC representative.

44

 

 

SECTION 6—ATTACHMENTS  

«Date»

	«Policyholder»	 	 	SAMPLE
	«StreetAddress»

«City», «State» «Zip»	 	 	 

	RE:
	«Insured Name»

«Account Number»

«Policy Number(s) and Effective/Expiration Date»

POLICYHOLDER DISCLOSURE STATEMENT UNDER  

 
 

TERRORISM RISK INSURANCE ACT OF 2002
  AND
  TERRORISM RISK INSURANCE EXTENSION ACT OF 2005    
    

You
are hereby notified that under the federal Terrorism Risk Insurance Act of 2002 (the "Act") effective November 26, 2002, and its amendment, the Terrorism Risk Insurance Extension Act of
2005 (jointly referred to as the "Act"), you now have a right to purchase insurance coverage for General Liability losses arising out of an Act of Terrorism, which is defined in the Act as an act
certified by the Secretary of the Treasury (i) to be an act of terrorism, (ii) to be a violent act or an act that is dangerous to (A) human life; (B) property or
(C) infrastructure, (iii) to have resulted in damage within the United States, or outside of the United States in case of an air carrier or vessel or the premises of a U.S. mission and
(iv) to have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United
States or to influence the policy or affect the conduct of the United States Government by coercion. You should read the Act for a complete description of its coverage. The Secretary's decision to
certify or not to certify an event as an Act of Terrorism and thus covered by this law is final and not subject to review. There is a $100 billion dollar annual cap on all losses resulting from
Acts of Terrorism above which no coverage will be provided under this policy and under the Act unless Congress makes some other determination. 

For
your information, coverage provided by this policy(ies) for losses caused by an Act of Terrorism may be partially reimbursed by the United States under a formula established by the Act. Under this
formula the United States pays 90% of terrorism losses covered by this law exceeding a statutorily established deductible that must be met by the insurer, and which deductible is based on a percentage
of the insurer's direct earned premiums for the year preceding the Act of Terrorism. 

Please
indicate your selection below. 

o    Coverage
for acts of Terrorism under your General Liability policy(ies) may be purchased for an annual premium amount of
$«underwriter enters premium». I hereby reject coverage and accept the Terrorism Exclusion on my policy(ies) in accordance with
the Act. 

Please contact your broker with any questions. 

	    
 Signature of Insured	 	 	 
	

    
 Print Name/Title	
 	

 	

 
	

    
 Date	
 	

 	

 

«Underwriter/Account
Manager» 

	cc:
	Broker

45

 

SECTION 7—COMMISSION

 
 

COMMISSION    
    

	AGENCY:	Marsh USA Inc.	 	ACCOUNT:	Gevity HR Inc,

ý    This
Binder is Net of Commission (check this box if no commission applies). 

Payment Of Counter Signature Fees (If Any) Shall Be The Responsibility Of The Agency.

SECTION 8—GLOSSARY

 
 

Aggregate Stop Amount    
    

The
maximum amount of benefits, damages and, if stipulated, Allocated Loss Adjustment Expense payable by you for losses under policies that are subject to your retention/deductible/loss reimbursement,
and (if applicable) self-insured retention insurance plan. 

 
 

Aggregate Stop Limit    
    

If
shown in conjunction with the Aggregate Stop Amount, the Aggregate Stop Limit is the maximum amount of benefits, damages and, if stipulated, Allocated Loss Adjustment Expense that we will not
require you to reimburse to us under your retention/deductible/loss reimbursement, and (if applicable) self-insured retention insurance plan. 

 
 

ALAE (Allocated Loss Adjustment Expense)    
    

Loss
adjustment expenses that are assignable or allocated to specific claims. "Allocated Loss Expenses" or "ALAE" will include, but are not limited to,
all fees for service of process and court costs and court expenses; pre- and post-judgment interest; attorney's fees; cost of undercover operative and detective services; costs
of employing experts; costs for legal transcripts, copies of any public records and costs of depositions and court-reported or recorded statements; costs and expenses of subrogation; and any similar
fee, cost or expense reasonably chargeable to the investigation, negotiation, settlement or defense of a loss or a claim or suit against you, or to the protection and perfection of either your or our
subrogation rights. ALAE also includes medical management Fees which may include medical bill audit fees, utilization management fees, network access fees and case management fees. 

ALAE
will not include loss adjustment expenses explicitly included in the premium calculation formula or otherwise explicitly included in the rating values, nor the salary, employee benefits, or
overhead of any of our employees, nor the fees of any attorney who is our employee or under our permanent retainer; nor the fees of any attorney we retain to provide counsel to us about our
obligations, if any, under any policy issued by us or our affiliated companies, with respect to a claim or suit against you. 

 
 

ALIR System    
    

Automobile
Liability Insurance Reporting software system used for the reporting of required vehicle data to the various state DMV offices. 

 
 

Automatic Withdrawal    
    

An
insured funded account established to facilitate the carrier's payment of the insured's losses and ALAE within the insureds deductible layer. The Insured authorizes the insurer to make withdrawals
as necessary and upon the insurer's demand from the account. The insured is obligated to fund the 

46

 

account
to cover expected losses and ALAE within the Insured's retained/deductible layer. The Insured is responsible to replenish the account as necessary. 

 
 

Basis of Adjustment    
    

Exposure
(such as payroll) and factor (such as a rate) used to determine a specific number or amount. 

 
 

Claims Payment Deposit    
    

The
amount deposited into the Claims Payment Fund. 

 
 

Claims Payment Fund    
    

"Claims
Payment Fund" is a non-interest bearing escrow fund established in the amount of two and one half (21/2) months' estimated Reimbursable Loss Plus Allocated Loss
Expenses. The Claims Payment Fund is deposited with the Claims Administrator for the payment of claims. The Claims Payment Fund is an estimated amount, and it will be adjusted depending upon the
actual claims paid. 

The
prior four months' paid losses will be reviewed by the Company to determine a two and one-half (21/2) month average. 

 
 

Claims Service Charges    
    

Fees
associated with the Third Party Administrator's handling of claims adjustment for a given account. 

 
 

Deductible    
    

The
amount of any damages or benefits arising out of any single accident, occurrence, claim or suit, paid or payable by you and which is not included in the computation of the  Subject Premium. 

 
 

Deferred Expense Provision    
    

Is
an estimated amount of expenses that you must pay as shown in the Schedule of Policies and Premiums to the Payment Agreement. 

 
 

Deferred Loss Provision    
    

Is
the estimated amount you must pay us as regular (usually billed monthly) loss payments and sizable loss payments as described in the Schedule of Policies and Premiums to the Payment Agreement. 

 
 

DMV    
    

Department
of Motor Vehicles. 

 
 

Estimated Deferred Amounts    
    

Estimate
of the Deferred Loss Provision and Deferred Expense Provision shown in the Schedule of Policies and Premiums to the Payment Agreement. 

 
 

Estimated Cost    
    

All
costs and amounts set out in the binder are considered estimated amounts subject to change prior to program binding and in the case of adjustable programs post program inception. Tax amounts
quoted through out the binder are estimated and subject to change based on revised tax rates and additional assessments that come due during the policy period 

47

 
 
 

Experience Modifications    
    

A
factor to adjust the premium in anticipation of loss experience that is expected to vary from the provision for losses in the rates. It is based upon the past variance of experience from expected
experience. 

 
 

FEIN numbers    
    

Federal
Employer Identification number. 

 
 

Guaranteed Cost Policies    
    

Policies
of insurance under which premium is charged on a prospective basis without adjustment for loss experience during the policy period. 

 
 

Incurred Loss Conversion    
    

Amendment
of a program from one in which you are reimbursing us for loss and expense actually paid out, to a program in which you are paying loss and expense actually paid out, but also for reserve
amounts established on pending claim activity. 

 
 

Insured States    
    

States
that are covered by insurance 

 
 

Loss Conversion Factor    
    

Are
factors used in the retention rating formula that provide a charge to cover the cost of the insurer's claims service fee. 

 
 

Loss Development Factors    
    

Loss
Development Factors shall mean those factors promulgated by the Company from time to time which are applied to Incurred Loss(es) to project Outstanding Loss Reserves and Allocated Loss Expense
Reserves to ultimate and contain a reserve for IBNR. 

 
 

Loss Reimbursement Limit    
    

The
portion of any loss and ALAE we pay that you must reimburse us for under any "Loss Reimbursement" provisions of a Policy. 

 
 

LRRP endorsement    
    

LRRP
(Large Risk Rating Plan) is RMG's version of the NCCI/ISO Large Risk Alternative Rating Option. The LRRP endorsement moves the adjustment process from the individual policies to the overall
program adjustment and moves expenses among different lines of insurance. 

 
 

Maximum Cost    
    

The
maximum amount that you must pay for the Subject Premium, and if applicable, non-subject premium, Self-Insured losses and ALAE. 

 
 

Maximum Insurance Cost    
    

Subject,
non-subject and deductible reimbursements and surcharges and special taxes. 

48

 
 
 

Maximum Premium    
    

Largest
amount that the subject premium can attain. 

 
 

Minimum Cost    
    

The
minimum amount that you must pay for the Subject Premium, and if applicable, non-subject premium, Self-Insured losses and ALAE. 

 
 

Monopolistic States    
    

Those
states where employers must obtain workers compensation insurance from compulsory state funds or qualify as a self-insurer. North Dakota, Ohio, Washington, West Virginia and Wyoming
(for certain codes only) are monopolistic states. 

 
 

Non-Ratable    
    

A
type of charge, especially in workers compensation rating, that is based on a catastrophic type exposure and is thus excluded from ordinary rate-making and is also not subject to
experience rating and retrospective rating. 

 
 

Non-Subject Premium    
    

All
other premium under a policy that is not subject to adjustment on the basis of loss adjustment. 

 
 

Plan Adjustment    
    

Recalculation
of the estimated premium from policy inception based on audited exposures and factors shown in the binder, plus losses and expenses, where applicable. 

 
 

Paid Loss adjustments    
    

Recalculation
of the estimated premium based on audited exposures and factors shown in the binder, plus the difference between losses and expenses you have paid to date and the losses and expenses
paid by us as of the loss and expense evaluation date used in the Paid Loss Adjustment. 

 
 

Paid Losses    
    

Losses
paid under the insurance program as they become due. 

 
 

Premium Deferral Plan    
    

Plan
under which the Insured and insurer agree to defer the insurance program premium over the course of the policy period. The Plan is set out in the schedule to the payment agreement and the insured
is obligated to provide collateral to secure for the deferred payment plan. 

 
 

Premium Discount    
    

A
discount granted to reflect expense savings relative to the size of the standard premium. 

 
 

Retention    
    

The
amount of any damages or benefits arising out of any single accident, occurrence, claim or suit, paid or payable by you and which is included in the computation of the  Subject Premium. 

49

 
 
 

Self-Insured Retention    
    

A
specific amount the Insured retains as its obligation for a covered loss. It is the Insured providing primary insurance over which the carrier provides excess coverage. Unlike a Deductible, the
Insurer is not obligated to pay the Insured's SIR and then seek reimbursement form the Insured. The insured is directly responsible to the claimant for the amount of the SIR. 

 
 

Self Insured States    
    

Those
states in which you, the insured, are providing the primary layer of insurance. 

 
 

Sizable Loss Payments    
    

A
set amount shown in the Payment Agreement schedule for which the Insured will be obligated to reimburse us following our payment of any Loss and ALAE within the Insured's retention. 

 
 

Stacking    
    

Refers
to a condition allowed in some states that permits you to add the policy limits of other vehicles covered by you, either on the same policy (interpolicy) or from other policies (intrapolicy),
and recover the sum of these limits. 

 
 

Standard Premium    
    

Premium
based upon the exposure rates and increase limit factors, but without application of premium discount or deductible discounts. 

 
 

Stop Gap Liability    
    

Provides
Employers Liability coverage for those states where employers must obtain statutory workers compensation insurance from a compulsory state fund. 

 
 

Subject Premium    
    

"Subject
Premium" is the portion of the Gross Program Premium subject to adjustments in accordance with the adjustment formula shown in this Binder. At the commencement of the program, it is the
amount stated on the Pricing Page. 

 
 

Texas Premium Discount    
    

Premium
discounts on automobile policies with premiums in excess of $5,000. These discounts are set when the policy is issued and cannot be changed until an audit of the policy is completed. 

 
 

UAIN    
    

Unemployment
Account Identification Number 

 
 

Ultimate Incurred Loss Plan    
    

Loss
Sensitive program in which you are paying, in advance of actual loss dollar payment, for the ultimate cost of expected losses and expenses that will occur during the policy period. 

 
 

Ultimate Losses    
    

Paid
losses and expense dollars, and reserve loss and expense dollars developed using Loss Development Factor(s) to establish the maximum expected total loss and expense amount. 

50

 
 
 

UM/UIM/PIP    
    

Uninsured
Motorist Coverage, Underinsured Motorist Coverage and Personal Injury Protection. All three are specific coverage available under a Business Auto, Truckers' or Garage Liability Policy. UM
and UIM coverage provides an insured with bodily injury (and in some states, property damage) coverage from its own carrier as if collecting from the tortfessor's carrier. PIP is a statutorily
provided coverage that has insurers provide first party benefits for medical expenses, loss of income, funeral expenses and such without regard to fault. 

 
 

Valuation Date    
    

The
cut off date for adjustments made to paid claims and reserve estimates in a loss report. 

51

QuickLinks

Exhibit 10.31

AIG Risk Management—National Accounts Division

Quality Service

Financial Strength

The Statements made are Subject To The Following Terms and Conditions

Workers' Compensation

Commercial General Liability

Commercial Automobile Liability

COMMERCIAL AUTOMOBILE TERRORISM RISK EXTENSION ACT OF 2005 NOTIFICATION

Additional Payments

Billing Method

Incurred Loss Accounting Adjustments

Documentation

Acquisitions and Divestitures

Estimated Premium Quoted in This Binder or Binder

Estimated Taxes and Assessments Quoted in this Binder For Loss Sensitive Programs/Plans

Premium Tax on Deductibles For Loss Sensitive Programs/Plans

Notice about the Office of Foreign Assets Control (OFAC)

Notice Applicable to Policies Issued Using the New York Trade Zone

Vermont Statute, Title 18: Health, Chapter 38: Lead Poisoning

Terrorism Risk Insurance Act Of 2002 And Terrorism Risk Insurance Extension Act Of 2005

Payment of Premium

Premium Audit

Overview

Special Account Instructions

Claims Reporting

Risk Management Information Systems (RMIS)

Executive Summary

TERRORISM RISK INSURANCE ACT OF 2002 AND TERRORISM RISK INSURANCE EXTENSION ACT OF 2005

COMMISSION

Aggregate Stop Amount

Aggregate Stop Limit

ALAE (Allocated Loss Adjustment Expense)

ALIR System

Automatic Withdrawal

Basis of Adjustment

Claims Payment Deposit

Claims Payment Fund

Claims Service Charges

Deductible

Deferred Expense Provision

Deferred Loss Provision

DMV

Estimated Deferred Amounts

Estimated Cost

Experience Modifications

FEIN numbers

Guaranteed Cost Policies

Incurred Loss Conversion

Insured States

Loss Conversion Factor

Loss Development Factors

Loss Reimbursement Limit

LRRP endorsement

Maximum Cost

Maximum Insurance Cost

Maximum Premium

Minimum Cost

Monopolistic States

Non-Ratable

Non-Subject Premium

Plan Adjustment

Paid Loss adjustments

Paid Losses

Premium Deferral Plan

Premium Discount

Retention

Self-Insured Retention

Self Insured States

Sizable Loss Payments

Stacking

Standard Premium

Stop Gap Liability

Subject Premium

Texas Premium Discount

UAIN

Ultimate Incurred Loss Plan

Ultimate Losses

UM/UIM/PIP

Valuation DateExhibit 10.14

 

HELICOS BIOSCIENCES CORPORATION

 

Amended and Restated Management
Incentive Bonus Plan

as of March 13, 2008

 

1.             Purpose

 

This Management Incentive Bonus Plan (the “Incentive Plan”) is
intended to provide an incentive for superior work and to motivate eligible
executives of Helicos BioSciences Corporation (the “Company”) and its
subsidiaries toward even higher achievement and business results, to tie their
goals and interests to those of the Company and its stockholders and to enable
the Company to attract and retain highly qualified individuals.  The Incentive Plan is for the benefit of
Covered Executives (as defined below) and does not govern the Company’s base salary and long-term
equity awards compensation practices.

 

2.             Covered
Executives

 

From time to time, the Compensation Committee of the Board of Directors
of the Company (the “Compensation Committee”) may select certain key
executives (the “Covered Executives”) to be eligible to receive bonuses
hereunder.  Other
individuals may become Covered Executives during a performance period provided
each such an individual is: (1) an employee of the Company; (2) recommended
for participation by the Chief Executive Officer; and (3) approved for
participation by the Compensation Committee.

 

3.             Administration

 

                The Compensation Committee shall
have the sole discretion and authority to administer and interpret the
Incentive Plan.  The responsibilities of the Compensation Committee and
Chief Executive Officer under the Incentive Plan shall be as follows:

 

·    Chief Executive Officer Responsibilities:

 

	
   

  	
  ·

  	
   

  	
  Recommend to the Compensation
  Committee the Covered
  Executives for
  Incentive Plan participation;

  
	
   

  	
  ·

  	
   

  	
  Propose performance measures,
  weightings, and performance levels for the Incentive Plan, and changes thereto;

  
	
   

  	
  ·

  	
   

  	
  Communicate Incentive Plan
  parameters and mechanics to Covered Executives;

  
	
   

  	
  ·

  	
   

  	
  Evaluate actual performance
  against bonus measures and goals;

  
	
   

  	
  ·

  	
   

  	
  Evaluate individual performance
  of the Covered Executives (except the Chief Executive Officer); and

  
	
   

  	
  ·

  	
   

  	
  Develop specific bonus
  recommendations for all Covered Executives
  (except the Chief Executive Officer) and submit to the Compensation Committee
  for review and approval.

  

 

 

 

·    Compensation
Committee Responsibilities:

 

	
   

  	
  ·

  	
   

  	
  Approve new Covered Executives;

  
	
   

  	
  ·

  	
   

  	
  Review and approve target bonus
  awards, including benchmarking to peer group companies;

  
	
   

  	
  ·

  	
   

  	
  Review and approve bonus
  measures, goals, and weightings;

  
	
   

  	
  ·

  	
   

  	
  Certify achievement of bonus
  measures;

  
	
   

  	
  ·

  	
   

  	
  Evaluate the Chief Executive
  Officer’s performance and determine and approve the Chief Executive Officer’s
  bonus based on such evaluation; and

  
	
   

  	
  ·

  	
   

  	
  Determine the bonus for Covered Executives based upon the Chief Executive Officer’s
  recommendations.

  

 

4.             Bonus
Determinations

 

(a)           A Covered Executive may receive a bonus
payment under the Incentive Plan based upon the attainment of corporate
performance targets approved by the Compensation Committee that relate to
financial, operational or strategic metrics with respect to the Company or any
of its subsidiaries (the “Corporate Performance Goals”) and the
individual performance of the Covered Executives (as determined by the Chief
Executive Officer for each Covered Executive other than himself) and approved
by the Compensation Committee.  The
Compensation Committee reserves the right to modify the Corporate Performance
Goals, the target bonus amounts and the weighting of the bonus payment between
corporate and individual performance at any time during the course of the
performance period in response to changing business goals, needs and
operations.

 

(b)           Except as otherwise set forth in this
Section 4 or with respect to individual performance determinations:  (i) any bonuses paid to Covered
Executives under the Incentive Plan shall be based upon objectively determinable
bonus formulas that tie such bonuses to one or more performance targets
relating to the Corporate Performance Goals, (ii) bonus formulas for
Covered Executives shall be adopted in each performance period by the
Compensation Committee and (iii) no bonuses shall be paid to Covered
Executives unless and until the Compensation Committee makes a determination
with respect to the attainment of the performance objectives.

 

(c)           Each Covered Executive shall have a
targeted bonus opportunity for each performance period.  The Company must attain the
minimum Corporate Performance Goals, as established by the Compensation
Committee, for any bonus payment to be made.  In the event
that the minimum threshold for achievement of the Corporate Performance Goals has
not been attained then no Covered Executive shall be eligible for the portion
of the target bonus opportunity attributable to individual performance.  Notwithstanding anything contained herein to
the contrary, the Company may adjust bonuses payable under the Incentive Plan
based on achievement of individual performance goals or pay bonuses (including,
without limitation, discretionary bonuses) to Covered Executives under the
Incentive Plan based upon such other terms and conditions as the Compensation Committee
may in its discretion determine.

 

(d)           A Covered Executive may be
awarded bonuses in excess of the targeted bonus opportunity, as determined by
the Compensation Committee, as a “Stretch” bonus amount if (i) the Company
exceeds the Corporate Performance Goals established by the Compensation 

 

 

2

 

Committee and/or (ii) the Company achieves at least the minimum
Corporate Performance Goals established by the Compensation Committee and the
individual performance of such Covered Executive is measured as
outstanding.  Notwithstanding the
foregoing, the
maximum bonus payable to a Covered Executive under the Incentive Plan shall not
exceed 200% of the Covered Executive’s target bonus opportunity.

 

(e)           The payment of a bonus to a Covered
Executive with respect to a performance period shall be conditioned upon the
Covered Executive’s employment by the Company on the last day of the
performance period; provided, however, that the Compensation Committee may make
exceptions to this requirement, in its sole discretion, including, without
limitation, in the case of a Covered Executive’s termination of employment,
retirement, death or disability.

 

5.             Performance
Period and Timing of Payment

 

This
Incentive Plan will measure and reward performance on an annual basis (January 1
— December 31).  The Corporate Performance Goals will be
measured at the end of each fiscal year after the Company’s financial reports
have been published.  If the Corporate
Performance Goals are met, payments will be made within 30 days thereafter, but
not later than March 15.

 

6.             Amendment and
Termination

 

The Company reserves the right to amend or terminate the Incentive Plan
at any time in its sole discretion.

 

7.             Miscellaneous

 

                The bonus
opportunity for individuals who become Covered Executives during a performance
period will be prorated based on the number of full and partial months
remaining in the performance period at the time Incentive Plan participation is
approved.  In the case of a Covered Executive’s death, total
disability or retirement during the plan year, a prorated award may be granted
in the sole discretion of the Compensation Committee based on the full-year
corporate results and the level of achievement of individual goals anticipated
had the Covered
Executive remained actively employed for the entire year.  The proration will be based on the number of
months worked.  Payment to a deceased Covered Executive will be made
to his/her estate.

 

                Nothing contained in this
document shall be deemed to alter the relationship between the Company and a Covered Executive, or the
contractual relationship between a Covered Executive and the Company if there is
a written contract regarding such relationship. 
Furthermore, nothing contained in this document shall be construed to
constitute a contract of employment between the Company and the Covered Executive.  The Company and each of the Covered Executives continue to
have the right to terminate the employment or service relationship at any time for
any reason, except as provided in a written contract.

 

3

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