Laserfiche WebLink
PN 04 99 04 <br />(Ed. 12-01) <br />POLICYHOLDER NOTICE <br />CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) SURCHARGE <br />Companies writing property and casualty insurance business in California are required to participate in the California <br />Insurance Guarantee Association. If a company becomes insolvent, the California Insurance Guarantee Association <br />settles unpaid claims and assesses each insurance company for its fair share. <br />California law requires all companies to surcharge policies to recover those assessments. If your policy is surcharged, <br />"CA Surcharge" or "CA Surcharge (CIGA Surcharge)" with an amount will be displayed on your premium notice. <br />This notice does not change the policy to which it is attached. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 09-07-21 Policy No. WC 80946 00 Endorsement No. <br />Insured BACKHAUS DANCE <br />Insurance Company Sirius America Ins Co <br />Countersigned By <br />©2001 by the Workers' Compensation Insurance Bureau of California. All rights reserved. <br />Premium $ Incl . <br />�oRaN <br />} r <br />RAMmVmentDMsian <br />REVIEWED & APPROVED BY.- <br />p PZ. vj&wd <br />Risk Management Analyst <br />