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CNA Workers Compensation <br />NOTICE OF CANCELLATION OR <br />MATERIAL CHANGE <br />ENDORSEMENT <br />J <br />This endorsement modifies insurance provided under the WORKERS COMPENSATION AND EMPLOYERS <br />LIABILITY INSURANCE POLICY: <br />In the event of cancellation or material change that reduces or restricts coverage during the policy period, we <br />agree to send prior written notice in the manner prescribed, to the person or organization listed in the Schedule. <br />SCHEDULE <br />1. Number of days advance notice: <br />For nonpayment of premium: <br />10 <br />For any other reason: <br />30 <br />2. Name and Address of Person or Organization: <br />Per schedule on file with the Company <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br />takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another <br />effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. <br />Form No: CNA873SOXX(11-2016) <br />Endorsement Effective Date: 8/30/2020 Endorsement Expiration Date: <br />Endorsement No: 1; Page: 1 of 1 <br />Underwriting Company: American Casualty Company of Reading, PA <br />© Copyright CNA All Rights Reserved. <br />Policy No: WC 6078988713 <br />Policy Effective Date:8/30/2020 <br />Policy Page: <br />[[iN <br />REVIEWED 6 APPROV® BY:: <br />F444 , Z VAVu:Ai <br />Rbk Management Analyst <br />