Employer Administrative Services Agreement



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Policy 1 Study ID 101 EMPLOYER ADMINISTRATIVE SERVICES AGREEMENT This Employer Administrative Services and Group Rating Plan Participation Agreement is entered into this day of 201, between (“Employer”) and V A Risk Services, LLC., (“V A”) NOW, THEREFORE, in consideration of the mutual promises and agreements contained herein, the parties hereto agree as follows: A.. Notifying V A of any material changes in the operation of the Employer, including, but not limited to, mergers, acquisition or significant adjustments to the employer’s payroll (such as an adjustment that results in changing the National Council on Compensation Insurance (“NCCI”) classifications under which the Employer was originally contracted with by V A.) For purposes of this Agreement, “significant adjustments to the Employer’s payroll” shall be defined as a reduction or increase in reported payroll in excess of 10 from the initial reported payroll or any change in the occupational classifications utilized by the Employer over the term of this Agreement.. V A shall not be liable for any awards, damages, penalties, fines, specific performance obligations, costs, expenses or any other loss or obligation arising from or relating to any action brought against the Employer alleging (i.) any workers’ compensation claim (ii) any claim for violation of a specific safety requirement (VSSR), (iii) any claim under Section 4123.90 of the Ohio Revised Code, (iv) any lawsuit for or based intentional tort, dual capacity or any other theory under which an employer is not immune under Section 4123.74 of the Ohio Revised Code or case law, (v.) any suit brought by a third party (vi) any enforcement action by any local, state, or federal agency..  

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