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G-20472-A <br />(Ed. 10/93) <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />NOTICE OF CANCELLATION OR MATERIAL CHANGE ENDORSEMENT <br />In the event of cancellation or other material change of the policy, we will mail advance notice to the person or <br />organization named in the Schedule. The number of days advance notice is shown in the Schedule. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />1. Number of days advance notice: <br />For non-payment of premium, the greater of: <br />• the number of days required by state statute or <br />• the number of days required by written contract <br />For any other reason, the lesser of: <br />• 60 days or <br />• the number of days required in a written contract <br />2. Notice will be mailed to: <br />Any person or organization you are required by written contract or agreement to mail prior written notice of <br />cancellation or matertal change. <br />Address: Per Certificates of Insurance on file with the broker <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 10.1-24 Policy No. WC274978630 Valley Forge Insurance Company <br />WC274978644 Transportation Insurance Company <br />APPROVED <br />By Cynthia Mora at 3:18 pm, Oct 30, 2024 <br />WC 99 06 06 <br />6-20472-A Page 1 of <br />(Ed. 10/93) <br />