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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br />This endorsement, effective 12:01 AM 03/01/2021 forms a part of Policy No. WC 113-26-672 <br />Issued to WOOLPERT, INC <br />By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. <br />LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL <br />TO ENTITIES OTHER THAN THE NAMED INSURED <br />(WORKERS' COMPENSATION ONLY) <br />This policy is amended as follows: <br />In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and <br />1. the cancellation effective date is prior to this policy's expiration date; <br />2. the Named Insured or, if applicable, any other employers named in Item 1 of the Information Page is under an <br />existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the <br />"Certificate Holder(s)") and the Named Insured has provided to the Insurer, either directly or through its <br />broker of record, the email address of a contact at each such entity; and <br />3. the Insurer received this information after the Named Insured receives notice of cancellation of this policy and <br />prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, <br />the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate Holders within 30 days <br />after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of days <br />is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable <br />after the Named Insured provides such information to the Insurer. <br />Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as <br />proof that the Insurer has fully satisfied its obligations under this endorsement. <br />This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or <br />the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. <br />The following definitions apply to this endorsement: <br />1. Named Insured means the insured first named employer in Item 1 of the Information Page of this policy. <br />2. Insurer means the insurance company shown in the header on the Information Page of this policy. <br />All other terms, conditions and exclusions shall remain the same. <br />AUTHOR <br />WC 99 00 56 <br />(Ed. 04/11) Archive Copy <br />�oRaN IZAManWmen DMsian <br />REVIEWED & APPROVED BY.- <br />3 z <br />Risk Management Analyst <br />