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CALIFORNIA WORKERS’ COMPENSATION INSURANCE <br />NOTICE OF NONRENEWAL <br />Section11664oftheCaliforniaInsuranceCoderequires4.Thepolicyisforaperiodofnomorethan60days <br />us,inmostinstances,toprovideyouwithanoticeofandyouwerenotifiedatthetimeofissuancethatit <br />nonrenewal.Exceptasspecifiedinparagraphs1may not be renewed. <br />through6below,ifweelecttononrenewyourpolicy,we5.Yourequestedachangeinthetermsorconditions <br />arerequiredtodeliverormailtoyouawrittennoticeorriskscoveredbythepolicywithin60dayspriorto <br />statingthereasonorreasonsforthenonrenewalofthethe end of the policy period. <br />policy.Thenoticeisrequiredtobesenttoyouno <br />earlierthan120daysbeforetheendofthepolicyperiod6.Wemadeawrittenoffertoyoutorenewthepolicy <br />andnolaterthan30daysbeforetheendofthepolicyat a premium rate increase of less than 25 percent. <br />period.Ifwefailtoprovideyoutherequirednotice,we <br />arerequiredtocontinuethecoverageunderthepolicy(A)Ifthepremiumrateinyourgoverning <br />withnochangeinthepremiumrateuntil60daysafterclassificationistobeincreased25percentor <br />we provide you with the required notice.greaterandweintendtorenewthepolicy,we <br />shallprovideawrittennoticeofarenewaloffer <br />Wearenotrequiredtoprovideyouwithanoticeofnotlessthan30dayspriortothepolicyrenewal <br />nonrenewal in any of the following situations:date.Thegoverningclassificationshallbe <br />determinedbytherulesandregulations <br />1.YourpolicywastransferredorrenewedwithoutaestablishedinaccordancewithCalifornia <br />changeinitstermsorconditionsortherateonInsurance Code 11750.3(c). <br />whichthepremiumisbasedtoanotherinsureror <br />otherinsurerswhoaremembersofthesame(B)ForpurposesofthisNotice,“premiumrate” <br />insurance group as us.meansthecostofinsuranceperunitof <br />exposurepriortotheapplicationofindividual <br />2.Thepolicywasextendedfor90daysorlessandtheriskvariationsbasedonlossorexpense <br />required notice was given prior to the extension.considerationssuchasscheduledratingand <br />experience rating. <br />3.Youobtainedreplacementcoverageoragreed,in <br />writing,within60daysoftheterminationoftheThisnoticedoesnotchangethepolicytowhichitis <br />policy, to obtain that coverage.attached. <br />Form PN 04 99 02 B (Ed. 5-02)Printed in U.S.A.Page2 of2 <br /> <br />