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WORKERS' COMPENSATION <br />CLAIMS ADMINISTRATION AGREEMENT <br />This Workers' Compensation Claims Administration Agreement (hereinafter referred to as <br />"Agreement") is made and entered into this day of 19 , between TRISTAR Risk <br />Management, (hereinafter referred to as "TRISTAR") and (hereinafter <br />referred to as the "Client"). <br />WHEREAS TRISTAR is in the business of providing Workers' Compensation claims adjusting <br />and administrative services on behalf of self-insured companies; and <br />WHEREAS CLIENT desires to purchase the service of TRISTAR and TRISTAR desires to <br />provide such services to the CLIENT with respect to its Workers' Compensation claims. <br />NOW, THEREFORE, in consideration of the initial covenants and agreements contained <br />herein, the parties hereto agree as follows: <br />I. CLAIMS ADJUSTING AUTHORITY AND RESPONSIBILITIES OF TRISTAR <br />1.1 Subject to all the terms and conditions of this AGREEMENT, TRISTAR shall <br />have the authority and responsibility to provide claims adjusting and <br />administration services to conclusion for the CLIENT in connection with claims <br />or losses relating to occurrences under the term of this AGREEMENT. <br />1.2 In connection with its authority and responsibilities under this AGREEMENT, <br />TRISTAR shall: <br />(a) Receive and examine, on behalf of the CLIENT, all claims reported to it <br />and initiate the process for the proper handling of each claim. <br />(b) Investigate and adjust, settle or deny all claims in accordance with <br />applicable requirements of any governing State Workers' Compensation <br />laws. <br />(c) Establish and maintain adequate reserves on each claim for which there <br />is injury and/or anticipated liability and/or a formal claim has been made <br />and code such claim in accordance with TRISTAR's routine statistical <br />requirements which may be modified, by mutual agreement, and <br />referenced by Addendum to this AGREEMENT. <br />