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WC 4426515-00 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY IN:! TRANCE POLICY <br />WC 0406 01 A <br />CALIFORNIA CANCELATION ENDORSEMENT <br />This endorsementapplies only to the insurance provided by the policy because California is shown in Item 3.A. of the <br />information page. <br />The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: <br />Cancelation I. The occurrence of a material change in the <br />1. You may cancel this policy. You must mail or deliv- ownership of your business; <br />er advance written notice to us stating when the <br />cancelation is to take effect. j• The occurrence of any change in your busi- <br />ness or operations that materially increases the <br />2. We may cancel this policy for one or more of the hazard for frequency or severity of loss; <br />following reasons: <br />a. Non-payment of premium; <br />b. Failure to report payroll; <br />c. Failure to permit us toaudit payroll as required <br />by the terms of this policy or of a previous <br />Policy issued by us; <br />d. Failure topay any additional premium resulting <br />from an audit of payroll required by the terms <br />of this policy or any previous policy issued by <br />us; <br />e. Material misrepresentation made by you or <br />your agent; <br />f. Failure tocooperate with us in the investigation <br />of a claim; <br />g. Failure to comply with Federal or State safety <br />orders; <br />h. Failure to comply with written recommen- <br />dations of our designated loss control repre- <br />sentatives; <br />k The occurrence of any change in your busi- <br />ness or operation that requires additional or <br />different classification for premium calculation; <br />I. The occurrence of any change in your busi- <br />ness or operation which contemplates an activ- <br />ityexcluded by our reinsurance treaties. <br />3. If we cancel your policy for any of the reasons <br />listed in (a) through (f), we will give you 10 days <br />advance written notice, stating when the cancel- <br />ation is to take effect. Mailing that notice to you at <br />your mailing address shown in item 1 of the Infor- <br />rnationPage willbe sufficient to prove notice. If we <br />cancel your policy for any of the reasons listed in <br />items (g) through (q, we will give you 30 days <br />advance written notice; however, we agree that In <br />the event of cancelation and reissuance of a policy <br />effective upon a material change in ownership or <br />operations, notice will not be provided. <br />4. The policy period will end on the day and hour <br />stated in the cancelation notice. <br />t '� <br />i1616131 iL6CCON-C_ _1-20 GL, AGr • . MC. PIOZ 6 Po11 I -a:. CeilifScaCe� ce g=: _ 10�3/20.3 t:33:2: PM. IPL�I ' Page 3 O( 3 <br />