Laserfiche WebLink
Miscellaneous Attachment: M467705 Certificate ID: 15567934 <br />0 <br />Blanket Notification to Others of Cancellation ZURICH <br />Policy No. <br />Eff. Date of Pol. <br />Exp. Date of Pol. <br />Eff. Date of End. <br />Producer No. <br />AddT Prem <br />Return Prem. <br />WC 9336626 <br />12/01/2017 <br />12/01/2018 <br />12/01/2017 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement modifies insurance <br />provided under the: Workers <br />Compensation policy <br />A. If we cancel this Coverage Part(s) by written notice to the first Named Insured for any reason other <br />than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation: <br />1. To the name and address corresponding to each person or organization shown in the Schedule <br />below; and <br />2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the <br />first Named Insured, or the longer number of days notice if indicated in the Schedule below. <br />B. This notice is intended only to be an advance notification to the person(s) or organization(s) named in <br />the Schedule of this endorsement in the event of pending cancellation of coverage. Our failure to <br />provide such advance notification to the person(s) or organization(s) shown in the Schedule of this <br />endorsement will not extend any policy cancellation date nor negate any cancellation of the policy. <br />C. If notice as described in Paragraph A. of this endorsement is mailed, proof of mailing will be sufficient <br />proof of such notice. <br />SCHEDULE <br />Name and Address of Other Person(s) / Organization(s): <br />Number of Days Notice: <br />All Certificate Holders where Notice of Cancellation is required by <br />written contract with the Named Insured <br />30 Days <br />All other terms and conditions of this policy remain unchanged. <br />REVIEWED BY: EUNICE HEREDIA (Peq OFI r } <br />