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WC 4426515-01 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 0406 01 A CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the information page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation i. The occurrence of a material change in the 1. You may cancel this policy. You must mail or deliv- ownership of your business, er advance written notice to us stating when the j. The occurrence of any change in your busi- cancelation is to take effect. ness or operations that materially increases the 2. We may cancel this policy for one or more of the hazardfor frequency orseverity of loss, following reasons: a. Non-payment of premium, b. Failure to report payroll, c. Failure to permit us toaudit payroll as required by the terms of this policy or of a previous policy issued by us, d. Failure topay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us, e. Material misrepresentation made by you or your agent, f. Failure tocooperate with us in the investigation of a claim, g. Failure to comply with Federal or State safety orders, h. Failure to comply with written recommen- dations of our designated loss control repre- sentatives, k. The occurrence of any change in your busi- ness or operation that requires additional or different classification for premium calculation, I. The occurrence of any change in your busi- ness or operation which contemplates an activ- ity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancel- ation is to take effect. Mailing that notice to you at your mailing address shown in item 1 of the Infor- mation Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in items (g) through (I), we will give you 30 days advance written notice, however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. The policy period will end on the day and hour stated in the cancelation notice. RWeMvwgwwdDW m RWIi ED&APPRovmlh- �S.ili1.11.IP'.L' Sn+*nmX�a (.sm.LanX ®, ® Rlsk Managemen[Supennsor s7613611 1 ELECCON-Cl 1 20-21 AL, A7, 7mb, WC, 3iof 6 loll I Angel Jimenez 1 9/26/2020 10:,0:21 _AM ('DT) I Sege 1, of 15