$5,000 GUARANTEE

 

We are so confident that our SureGrip® slip resistant footwear will help reduce slips and falls in your workplace, we pledge to pay up to $5,000 towards direct medical expenses paid by you (Company) for injuries sustained from slip and fall accidents by any of your Company employees wearing a pair of SureGrip® footwear purchased through a payroll deduction plan or through a 100% subsidized company purchase.

1. The employee must have been wearing a pair of SureGrip® footwear purchased through a payroll deduction program or a 100% subsidized company program within 6 months of the accident date.

4. Maximum reimbursement during the calendar year is 10% of the company’s net purchase of the SureGrip® footwear for the calendar year in which the accident occurs.

5. Keuka® Footwear, Inc. (hereinafter referred to as "SureGrip® Footwear") reserves the right to require written certification by the employee and/or the manager confirming any of the above conditions on the form(s) provided, by SureGrip® Footwear.

6. If the Company is more than sixty (60) days delinquent in its payment of any SureGrip® Footwear invoices, this CONFIDENCE GUARANTEE may be canceled at anytime.

7. SureGrip® Footwear reimbursements via the CONFIDENCE GUARANTEE are for direct medical expenses only. Claims other than direct medical expenses will not be considered for payment including but not limited to expenses due to lost time at work.

10. ShoeGuard® is a shoe covering and does not possess the same fit characteristics as SureGrip® footwear. Therefore, ShoeGuard® is excluded from the warranty.

No reimbursement amount shall be paid to the CONFIDENCE GUARANTEE Participating Company for any accident, which is not reported in writing to SureGrip® Footwear within twenty-one (21) days of the date of the accident.

This CONFIDENCE GUARANTEE shall automatically terminate upon the termination of the Employee Payroll Deduction Plan or the 100% company subsidized program with SureGrip® Footwear.

When a location Manager informs your Corporate Risk/Safety Manager that an employee has incurred a slip and fall accident wearing SureGrip® SureGrip® Slip-resistant footwear, the following process is to be followed:

4. The Corporate Safety/Risk Manager must send the accident report to SureGrip® Footwear within twenty-one (21) days of the incident. Please send these forms to:

Upon review, SureGrip® Footwear will reimburse your company the lesser of either $5,000 or the completed claim amount for direct medical expenses only, not to exceed 10% of the Company’s net purchases for the year, after you forward us a copy of the claim closure from your insurance carrier or any other proof that you paid direct medical expenses for this claim.

Subject to the definitions, terms and conditions set forth below, SureGrip®Footwear hereby agrees to pay the CONFIDENCE GUARANTEE participating company the direct medical expenses paid by the CONFIDENCE GUARANTEE participating company, provided the claim is for injuries sustained by the employee as a result of a slip and fall accident while the employee is wearing SureGrip® slip-resistant shoes. The SureGrip® footwear needs to be

purchased via a SureGrip® Footwear payroll deduction plan or a 100% company subsidized program within a six-month period prior to the accident.

A. A "CONFIDENCE GUARANTEE Participating Company" is a company having an employee payroll deduction plan or a 100% subsidized program with SureGrip® Footwear in effect on the date the company applies for reimbursement from SureGrip® Footwear.

A. No reimbursable amount shall be paid by SureGrip® Footwear to the CONFIDENCE GUARANTEE Participating Company if such reimbursable amount would cause the total reimbursable amounts paid to the CONFIDENCE GUARANTEE Participating Company during the Calendar year to exceed ten percent (10%) of the CONFIDENCE GUARANTEE Participating Company’s net purchases of SureGrip® Footwear slip-resistant shoes during the calendar year.

B. No reimbursable amount shall be paid by SureGrip® Footwear to the CONFIDENCE GUARANTEE Participating Company if the accident occurred due to tripping on an object on the floor, icy surface, cooler areas, freezer areas, in subzero area, or in any other climatic controlled areas. SureGrip® Footwear reimbursements via the CONFIDENCE GUARANTEE are for direct medical expenses only. Claims other than direct medical expenses will not be considered for payment including but not limited to expenses due to lost time at work. This limited warranty is only valid for slips and falls that occur on the floor at the Company's workplace. Stairs are expressly excluded from any coverage in any form within the context of the warranty.

C. This limited warranty may be canceled by SureGrip® Footwear at any time if the CONFIDENCE GUARANTEE Participating Company is more than Sixty (60) days delinquent in its payment of any SureGrip® Footwear invoice.

D. No reimbursable amount shall be paid to the CONFIDENCE GUARANTEE Participating Company for any accident, which is not reported in writing to SureGrip® Footwear within twenty-one (21) days of the date of the accident. SureGrip® Footwear reserves the right to condition payment of such reimbursable amount to the CONFIDENCE GUARANTEE Participating Company upon receipt of written certification by the injured employee or the manager as to the facts and circumstances of such accident.