Laserfiche WebLink
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ARIZONA CANCELLATION AND NONRENEWAL ENDORSEMENT <br />Policy Number: 59 WEC AC9055 Endorsement Number: <br />Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: BAY SPROUTS LLC <br />655 S MAIN ST STE 200-317 <br />ORANGE CA 92868 <br />This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. <br />Part Six - Conditions, Section D. (Cancellation), of the policy is replaced by the following: <br />D. Cancellation and Nonrenewal <br />1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is <br />to take effect. <br />2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. <br />3. We may cancel this policy if you fail to pay premium when due, or when one or both of the parties to a <br />professional employer agreement terminate the agreement. <br />4. If we cancel or nonrenewal this policy, we must mail or deliver to you and the Industrial Commission of Arizona at <br />least 30 days' notice of the cancellation or nonrenewal. Mailing that notice to you at your mailing address shown <br />in Item 1. of the Information Page will be sufficient to prove notice. If we nonrenew this policy and fail to give you <br />notice of nonrenewal, coverage will not extend beyond the policy period. <br />5. The policy period will end on the day and hour stated in the cancellation or nonrenewal notice. <br />Form WC 02 06 01 A Printed in U.S.A. <br />Process Date: 05/25/20 <br />ew cF RAMwagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />,v <br />POlic R.Wjanagementftalpt <br />