RULE III – POLICY PREPARATION – INSURED, POLICY PERIOD AND STATE OF OPERATIONS

Item 1, 2 and 3-A of the Information Page

1. Employer/Entity
   Employer may be an individual, partnership, joint venture, corporation, association, or a fiduciary such as a trustee, receiver or executor, or other entity.
2. Insured
   Insured means the employer designated in Item 1 of the Information Page. If the insured is a professional association, use the Professional Association Act Endorsement in Section 3 of this Manual.
3. Majority Interest
   Majority Interest as defined in the Experience Rating Plan Section applies. The term majority shall mean more than 50%.

1. 1.  United States Longshore and Harbor Workers’ Compensation Act.
   2.  Majority of voting stock, or
   3. Majority of members or directors if there is no voting stock, or
   4. Majority participation of general partners in profits of a partnership

4. Risk
     Risk means a single legal entity or two or more legal entities which qualify for combination in the state of Pennsylvania.

1. Name of Insured
   In addition to providing the complete legal name of the insured, carriers shall designate each fictitious name shown on the Information Page by the symbol D.B.A. (doing business as). In addition, if a fictitious name is shown on an endorsement the same designation, D.B.A., shall be shown. A fictitious name is a business name which is not the legal name of the insured.The effective date of any change, addition or deletion in the name of the insured shall be shown on the endorsement.Name and address changes should be effected on a separate endorsement and not in conjunction with other policy amendments.

2.   Combination of Legal Entities

Separate legal entities may be insured in one policy only if the same person, or group of persons, owns the majority
interest in such entities.

    3.   Pennsylvania Locations

All locations and operations of the employer in Pennsylvania shall be insured in one policy. Exception: Long Term
Construction Projects (Wrap-up). See Rule IX-D

1.  Normal Policy Period

The normal policy period is one year. A policy may be issued for any period but not longer than 3 years.

2.  Policy for One Year

a.  The manual rules are based on a policy period of one year.

b.  A policy issued for a period not longer than one year and 16 days is treated as a one year policy.

3. Policy Longer Than One Year

A policy issued for a period longer than one year and 16 days, other than a 3-year fixed carrier rating value policy, is
treated as follows:

a.  The policy period is divided into consecutive 12-month units.

b.  If the policy period is not a multiple of 12 months, use the Standard Policy Period Endorsement(WC 00 04 05) to
specify the first or last unit of less than 12 months as a short-term policy.

c.  All manual rules and procedures apply to each such unit as if a separate policy had been issued foreach unit.

4. Renewal Certificates, Agreements and Continuing Form Policies, should be handled as policies longer
than one year.

5. Three-Year Fixed Carrier Rating Value Policy Option

A policy may be issued for a period of 3 years at fixed carrier rating values. Such a policy shall not be issued if the risk is
subject to the Experience Rating Plan on the effective date of the policy.

A policy issued under this option shall be known as a Three-Year Fixed Carrier Rating Value Policy and shall be so
designated on the Information Page. Refer to Rule XI.

6.  Annual Rating Endorsements

An “Annual Rating Endorsement” shall be submitted annually for each continuing form policy or policy written for a
period in excess of one year but not more than three years to be effective on the annual policy effective date set by such
policy. It shall be submitted to the PCRB not later than thirty days subsequent to its inception.

Annual rating endorsements shall also:

a. Show the name of the carrier providing the insurance. If the names of affiliated carriers are printed on endorsement
forms, the particular carrier providing coverage shall be clearly indicated.

b. Show the policy number, including all printed and typed prefixes to facilitate the identification of the policy to which
the Annual Rating Endorsement is related.

c. If the annual rating endorsement being filed replaces an annual rating endorsement covering the same period,
indicate that it is a rewrite.

d. Show the date of its inception and expiration.

e. Show the code number(s) and carrier rate(s) applicable. If the carrier rate(s) or experience modification is not
effective as of inception date of the endorsement, also show the effective date of such carrier rate(s) or modification.

f. Show the premium adjustment period, deposit premium and estimated annual premium for the period covered by the
Annual Rating Endorsement.

Annual Rating Endorsements shall be used only for the purpose of showing the carrier rates, experience modifications,
premium adjustment period, deposit premium and estimated annual premium for each one-year period. They cannot be
used to make any other changes in the policy such as, but not restricted to, modifying the name of the insured, adding or
eliminating classifications, adding or eliminating locations.

1. Listing of Pennsylvania

Insurance for operations conducted in Pennsylvania is provided by listing the state in Item 3-A of the Information Page.

2. Longshore Act

The U.S. Longshore and Harbor Workers Compensation Act shall not be entered in Item 3-A of the Information Page.
Refer to Rule XII.

3. Additional States

A state may be added after the effective date of the policy. For the additional state operations apply:

     a. Carrier rating values in effect on the effective date of the policy to which the state has been added.

     b. Any change in carrier rating values which apply to outstanding policies for the state being added.

     c. When adding the State of Pennsylvania, the Information Page and attached endorsements shall be prepared so that
the Pennsylvania coverage can be clearly determined.