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P N 04 99 02 B (Ed. 5-02) We are not required to provide you with a notice of nonrenewal in any of the following situations: Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. The policy was extended for 90 days or less and the required notice was given prior to the extension. You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A) If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations established in accordance with California Insurance Code Section 11750.3(c). (B) For purposes of this Notice, "premium rate" means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating. This notice does not change the policy to which it is attached. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09-07-21 Policy No. WC 80946 00 Endorsement No. Insured BACKHAUS DANCE Insurance Company Sirius America Ins Co Countersigned By ©2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Premium $ Incl . �oRaN } z a RiskMmaganadDiviaiun REVIEWED & APPROVED BY.- F R. vj&wd Risk Management Analyst