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Miscellaneous Attachment: M463462 Certificate ID: 15595159 <br />POLICY NUMBER: WC0081062 <br />NAMED INSURED: SEE ATTACHED CERTIFICATE <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />U-W C-332-A <br />NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT <br />This endorsement is used to add the following to Part Six of the policy. <br />PART SIX - CONDITIONS <br />F. Notification To Others Of Cancellation <br />1. If we cancel this policy by written notice to you for any reason other than nonpayment of <br />premium, we will deliver electronic notification to each person or organization shown in a <br />Schedule provided to us by you. <br />Such Schedule: <br />a. Must be initially provided to us within 15 days: <br />After the beginning of the policy period shown in the Declarations; or <br />After this endorsement has been added to policy; <br />b. Must contain the names and e-mail addresses of only the persons or organizations requiring <br />notification that this policy has been cancelled; <br />c. Must be in an electronic format that is acceptable to us; and <br />d. Must be accurate. <br />Such Schedule may be updated and provided to us by you during the policy period. Such <br />updated Schedule must comply with Paragraphs b. c. and d. above. <br />2. Our delivery of the electronic notification as described in Paragraph 1. of this endorsement will be <br />based on the most recent Schedule in our records as of the date the notice of cancellation is <br />mailed or delivered to you. Delivery of the notification as described in Paragraph 1. of this <br />endorsement will be completed as soon as practicable after the effective date of cancellation to <br />you. <br />3. Proof of emailing the electronic notification will be sufficient proof that we have complied with <br />Paragraphs 1. and 2. of this endorsement. <br />4. Our delivery of electronic notification described in Paragraphs 1. and 2. of this endorsement is <br />intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: <br />a. Extend the policy cancellation date; <br />b. Negate the cancellation; or <br />c. Provide any additional insurance that would not have been provided in the absence of this <br />endorsement. <br />5. We are not responsible for the accuracy, integrity, timeliness and validity of information contained <br />in the Schedule provided to us as described in Paragraphs 1. and 2. of this endorsement. <br />All other terms and conditions of this policy remain unchanged. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless <br />otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to <br />preparation of the policy.) <br />RlaleMnnagemortDivision <br />"\s REVIEWED 6 APPROVED Or <br />R6k Management Analyst <br />