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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />MWC 1404 05 ~ n <br />OPTIONAL PREMIUM INCREASE ENDORSEMENT -CALIFORNIA <br />You are required to allow us, or an authorized representative of our company, access to your records when <br />conducting an audit. If you fail to allow us to audit your records within 90 days after expiration of the policy, we <br />may charge a total premium up to 3 times our current estimate of the annual premium for your policy. <br />Additionally, if you fail to allow access after our third request within a 90 day or longer period, you are also liable <br />for our costs in attempting to perform the audit unless you provide a compelling business reason for your failure. <br />We will notify you when the premium will be increased and how much the premium will be by sending certified, <br />return-receipt notification to you. Payment will be due within 30 days of receipt of the notification. <br />If we are allowed access to audit your records within three years after the policy expiration date, or another agreed <br />upon time, we will amend the total premium in accordance with the audit results. <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 12/01 /2011 Policy No. MW00017162-01 Endorsement No. <br />Insured Santa Ana Police Officers <br />Association (a nonp <br />Insurance Company Markel Insurance Company Countersigned by <br />©2008 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />20 of 28 <br />