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Last modified
4/28/2022 9:27:34 AM
Creation date
7/13/2021 2:59:02 PM
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Contracts
Company Name
AEF SYSTEMS CONSULTING
Contract #
N-2021-144
Agency
Parks, Recreation, & Community Services
Expiration Date
6/30/2022
Insurance Exp Date
8/23/2022
Destruction Year
2027
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA <br />Policy Number: 72 WEC AB1Z5Q Endorsement Number: <br />Effective Date: 02/01/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AEF Systems Consulting Inc <br />8502 E CHAPMAN AVE STE 376 <br />ORANGE CA 92869 <br />You must provide us, or our authorized representative, <br />access to records necessary to perform a payroll <br />verification audit. If you fail to provide access within 90 <br />days after expiration of the policy, you are liable to pay a <br />total premium equal to 3 times our current estimate of <br />the annual premium for your policy. In addition, if you fail <br />to provide access after our third request within a 90 day <br />or longer period, you are also liable for our costs in <br />attempting to perform the audit unless you provide a <br />compelling business reason for your failure. <br />We will contact you to schedule appointments during <br />normal business hours. <br />We will notify you of your failure to provide access by <br />mailing a certified, return -receipt document stating the <br />increased premium and the total amount of our costs <br />incurred in our attempt(s) to perform an audit. In addition <br />to any other obligations under this contract, 30 days <br />after you receive the notification, you will be obligated to <br />pay the total premium and costs referenced above. If, <br />thereafter, you provide access to your records within <br />three years after the policy expires, or within another <br />mutually agreed upon time, and we succeed in <br />performing the audit to our satisfaction, we will revise <br />your total premium and the costs due to reflect the <br />results of the audit. <br />Form WC 04 04 21 Printed in U.S.A. <br />Process Date: 12/23/19 Policy E) <br />Rids Mtougement Dtwefan <br />a REnenm&APPRov®ar. <br />�' Risk Management Analyst <br />
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