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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 43 <br />BLANKET NOTIFICATION TO OTHERS OF CANCELLATION OR NONRENEWAL ENDORSEMENT <br />This endorsement adds the following to Part Six of the policy. <br />PART SIX <br />CONDITIONS <br />Blanket Notification to Others of Cancellation or Nonrenewal <br />1. If we cancel or non -renew this policy by written notice to you, we will mall or deliver notification that such policy <br />has been cancelled or non -renewed to each person or organization shown in a list provided to us by you if you <br />are required by written contract or written agreement to provide such notification. However, such notification <br />will not be mailed or delivered if a conditional notice of renewal has been sent to you. Such list: <br />a. Must be provided to us prior to cancellation or non -renewal; <br />b. Must contain the names and addresses of only the persons or organizations requiring notification that <br />such policy has been cancelled or non -renewed; and <br />c. Must be in an electronic format that is acceptable to us. <br />2. Our notification as described in Paragraph 1. above will be based on the most recent list in our records as of <br />the date the notice of cancellation or nonrenewal Is mailed or delivered to you, We will mail or deliver such <br />notification to each person or organization shown in the list: <br />a. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of <br />premium; or <br />J, At least 30 days prior to the effective date of; <br />(1) Cancellation, if cancelled for any reason other than nonpayment of premium; or <br />(2) Nonrenewal, but not including conditional notice of renewal. <br />3. Our Melling or delivery of notification described In Paragraphs 1, and 2. above Is intended as a courtesy only. <br />Our failure to provide such Melling or delivery will not: <br />a. Extend the policy cancellation or nonrenewal date; <br />b, Negate the cancellation or non -renewal; or <br />c. Provide any additional Insurance that would not have been provided In the absence of this endorsement, <br />4. We are not responsible for the accuracy, Integrity, timeliness and validity of Information contained in the list <br />provided to us as described in Paragraphs 1. and 2, above. <br />All other terms and conditions of this policy remain unchanged. <br />This endorsement changes the policy to which It is attached and is effective on the date issued unless otherwise stated. <br />(The Information below Is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 10.01.2018 policy No. WC 1387067.00 Endorsement No. <br />Insured Premium $ <br />Insurance Company Zurich American Insurance Company <br />WC 99 66 43 page 1 of 1 <br />(Ed. 01.13) Includes copyright material of the National Council on Compensation Insurance, Inc. used with Its permission. <br />02012 Copyright National Council on Compensation Insurance, Inc, All Rights Reserved. <br />�EVIEWECBX._.T,.—T,-...-_--._..,,...,.EUNICE hICREpIA (Pe/Qgr((%,), <br />