Limited Indemnity

SR Max- a division of Saf-Gard Safety Shoe Co. (“SR Max”) agrees to reimburse any company participating in It’s SR Max Payroll Deduction Plan for any direct medical expenses paid by said company resulting from injuries sustained by an employee of said company from a slip and fall accident while wearing SR Max shoes purchased from SR Max.

Conditions and Exceptions:

1. At the time of any reimbursable accident, the injured employee must be wearing shoes purchased in that employee’s name within the last six (6) months through SR Max’s Payroll Deduction Plan and the shoes worn by such injured employee must be an SR Max style listed in the “Approved Style for SR Max Limited Indemnity List” which is included as part of this indemnity below.  Shoes worn by such injured employee must be specifically included on an approved listing for the claiming organization. 
2. Styles not included on the Approved Style List for SR Max Limited Indemnity, SR Max styles not so recommended for the organization, and SR Max styles not specifically purchased in the injured employee’s name are specifically excluded from this offer.
3. Accidents resulting from objects on the floor or from icy surfaces, in freezers, coolers or subzero environments are specifically excluded.  Acceptable surfaces include water, grease, liquefied fats and synthetic lubricants.
4. The maximum amount of an individual claim for which SR Max will be responsible is limited to the lesser of $5,000 or the total claim amount.
5. Maximum total reimbursement for any calendar year is limited to ten percent of the net purchase for that calendar year of SR Max shoes by the claiming company.
6. SR Max reserves the right to require a written statement by the injured employee confirming any of the conditions specified above in a form satisfactory to SR Max.
7. This offer of limited indemnity shall automatically cancel if the claiming company is more than sixty (60) days delinquent on any invoices from SR Max.
8. The limited indemnity covers only slips and falls that occur on the floor of claiming company’s workplace.
9. Any right and/or reimbursement available to claiming company for separate “manufacturer” slip and fall indemnity, pledge, or warranty is assigned to SR Max upon the claiming company’s submittal of a claim to SR Max.

Claims and Procedures:

Upon the occurrence of an accident covered by this limited indemnity, the claiming company must report the same to SR Max in a form satisfactory to SR Max within twenty-one (21) days of such accident.  Failure to so notify SR Max within such time period will result in SR Max’s denial of the claim.

Termination:

This offer of limited indemnity shall automatically be cancelled upon the claiming company’s termination of its Employee Payroll Deduction Plan with SR Max.

Venue:

This offer of limited indemnity shall be governed by the laws of the State of North Carolina.  The venue for any claim or action arising out of this agreement shall be in the state or federal courts located in Guilford County, North Carolina.

Approved Style List for SR Max Indemnity

62010	DICD3230	RW6314	SK76340WHT	SK76753BLK
66005	DICD3240	RW6315	SK76355BBK	SK76753DSCH
66010	DICD3241	RW6318	SK76355STNV	SK76755BLK
66019	DICD3280	RW6319	SK76355WHT	SK76756BLK
66020	DICD4062	RW6320	SK76356BBK	SK76778BLK
66025	DICD4080	RW6333	SK76356WHT	SK76778WHT
66050	DICD4090	RW6335	SK76360BLK	SK76789BLK
66090	DICD4220	RW6374	SK76360TOFF	SRM120
66205	DICD4223	RW6384	SK76362BLK	SRM1200
68010	DICD4230	RW6390	SK76381BLK	SRM130
68011	DICD4240	RW6394	SK76381WHT	SRM1300
68020	DICD4280	SK4296BWXV	SK76397BLK	TM53552
68030	DICD5210	SK76009B	SK76607BLK	TM53556
68035	DICD6210	SK76009WHT	SK76690BLK	TM53559
68036	FS108	SK76010BWXV	SK76690WHT	TM61394
68040	FS109	SK76011BWXV	SK76713BLK	TM61396
DICD1010	FS208	SK76012BWXV	SK76717BLK	TM61398
DICD1040	FS209	SK76033B	SK76717CDB	WGC105
DICD1090	NBMW631BK	SK76033W	SK76737BLK	WGC1050
DICD1190	NBWW631BK	SK76038BLK	SK76739BLK	WGC110
DICD1210	RW5334	SK76040BLK	SK76740BLK	WGC1100
DICD1240	RW5335	SK76083BWXV	SK76740BRN	WGC111
DICD1250	RW5345	SK76225BLK	SK76741BLK	WGC1110
DICD1290	RW6100	SK76225WHT	SK76741RDBR	WGC124
DICD3220	RW6106	SK76340BLK	SK76748BLK	WGC1240
DICD3221	RW6308

	SR Max Customer Signature:		_______________________
	SR Max Customer Printed Name:		___________________Date:_______

 

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