Note: Print this Indemnity Agreement on company letterhead. INDEMNITY AGREEMENT BY THE PARENT COMPANY FOR SUBSIDIARIES KNOWN ALL BY THESE PRESENTS, THAT , organized and existing under and by virtue of the laws of the State of (the 223Parent224), guarantees payment of the compensation, assessments, contributions , or other amounts that may become due under the provisions of Oregon Revised Statute (ORS) c hapter 656 in the event that , a subsi diary of Parent , or any other entity that is or has been approved by the department for inclusion and included in a self - insurance certification in which such subsidiary has been included (the named subsidiary and such other entities, collectively, the 223Subsidiaries224), shall not pay, or cause to be paid, compensation or any assessments, contributions, or other amounts that may become due under ORS chapter 656. The undersigned Parent covenants and agrees that it will pay such compensation, assessments, contributions, or amounts that may become due, with the express agreement and understanding that Parent does recognize and accepts this agreement as a direct financial guarantee of said compensation, assessments, contributions, or other amounts that may become due. This agreement shall remain in effect until the earlier of (i) the termination of all self insured certifications for all Subsidiaries, or (ii) the Oregon Department of Consumer and Business Services releases Parent in writing from the obligations set forth in this agreement; provided that such termination or release shall not affect Parent222s liability for any compensation, assessments, contributions, or other amounts for which it has responsibility under this agreement for liability that arose or is based on events occurring prior to the termination or release. This agreement shall be effective Executed at this day of , 20 . FOR PARENT: ATTEST: 440 - 4966 ( 9 /1 7 /DCBS/WCD/WEB) American LegalNet, Inc. www.FormsWorkFlow.com