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Attachment Code: D572922 Certificate ID: 15085893 <br />SAFETY NATIONAL CASUALTY CORPORATION <br />ST. LOUIS, MISSOURI <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 23 <br />90 DAY CANCELLATION ENDORSEMENT - CALIFORNIA <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />Under Part Six - Conditions, Item 2 of Paragraph D. Cancellation is amended to read: <br />2. We must mail or deliver to you not less than 90 days advanced written notice stating when the cancellation is <br />to take effect, except for when cancellation of the policy is for non-payment of premium. If cancellation of the <br />policy is for non-payment of premium, we must mail or deliver to you not less than ten days advance written <br />notice stating when the cancellation is to take effect. Mailing such notice to you at your mailing address <br />shown in Item 1 of the Information Page will be sufficient to prove notice. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 1/1/2021 <br />Insured MISSION LINEN SUPPLY <br />Policy No. LDS4045504 <br />Insurance Company Safety National Casualty Corporation <br />WC 99 04 23 (07 11) <br />Endorsement No. <br />Premium $ Included <br />o 1. REmEwED I`ve r.. <br />®. <br />Risk Management Analyst <br />