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C H U B B• Policy Conditions <br />Endorsement <br />Policy Period <br />Effective Date <br />Policy Number <br />Insured <br />Name of Company <br />Date Issued <br />This Endorsement applies to the following forms: <br />COMMON POLICY CONDITIONS <br />Conditions <br />MAY 17, 2021 TO MAY 17, 2022 <br />MAY 17, 2021 <br />3602-53-12 TPA <br />CIVICPLUS,LLC <br />GREAT NORTHERN INSURANCE COMPANY <br />JUNE 4, 2021 <br />The following changes are made as respects exposures in the state of Kansas. <br />Under Conditions, Cancellation and When We Do Not Renew are deleted and replaced by the <br />following: <br />Cancellatlon We may cancel this policy by mailing or delivering to the first Named Insured written notice of <br />cancellation, stating the reasons for cancellation, at least: <br />• 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or <br />• 30 days before the effective date of cancellation if we cancel for any other reason. <br />If this policy has been in effect for 90 days or more, or if it is a renewal of a policy we issued, we <br />may cancel this policy only for one or more of the following reasons: <br />• nonpayment of premium; <br />• this policy was issued because of a material misrepresentation; <br />• you or any other insured violated any of the material terns and conditions of this policy; <br />• unfavorable underwriting factors, specific to the insured, existed that were not present at the <br />inception of this policy; <br />RWi M"Pa dmw `.. <br />atom& A� Br <br />Policy Caretion8 KaneBB Mandatory �c u <br />Form 80-02-9737(Ed. 3-96) Erxioraement .xm.,r,.,ye�nCl,iwade <br />