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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 A <br />EEC Environmental dba Enviromental Engineering Contracting Inc., (Ed. 12/ 93 ) <br />XWS(22)58333458 <br />CALIFORNIA CANCELATION ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the <br />INFORMATION PAGE. <br />The cancellation condition in Part Six (Conditions) of the policy is replaced by these conditions: <br />CANCELATION <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. We may cancel this policy for one or more of the following reasons: <br />a. Non-payment of premium; <br />b. Failure to report payroll; <br />c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; <br />d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or <br />any previous policy issued by us; <br />e. Material misrepresentation made by you or your agent; <br />f. Failure to cooperate with us in the investigation of a claim; <br />g. Failure to comply with Federal or State safety orders; <br />h. Failure to comply with written recommendations of our designated loss control representatives; <br />i. The occurrence of a material change in the ownership of your business; <br />j. The occurrence of any change in your business or operations that materially increases the hazard for <br />frequency or severity of loss; <br />k. The occurrence of any change in your business or operation that requires additional or different classification <br />for premium calculation; <br />Copyright 1998by The Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />From the WCIRB's California Workers' Compensation Insurance Forms Manual Copyright 1994 <br />INSURED <br />61969354 120-21 G/A/UMB/POLL/E&O 21-22 WC I Jennifer Barton 15/26/2021 10:30:41 AM (PDT) I Page 11 of 11 <br />r.� <br />z: <br />Risk Management Division <br />REVIEWED & APPROVED BT <br />x <br />c�31�i�LL�f:1` <br />r IIAJ+Ga.J+C P,. Y+XXA44d <br />® <br />Risk Management Analyst <br />