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El <br />Item 3 of tip Information Page are s❑❑iect to <br />cE:Onge if ordered ❑y t e Insr7ance Commissioner <br />of tDO State of California pL]rsi:ant to Section 11 i❑3❑ <br />of t❑e California Ins:lrance Code. <br />Long Term Policy. If tEls policy is written for a <br />period longer tDan one year, all t❑a proElsions of <br />tEls policy smell apply separately to eac❑ <br />consecEliC:o twel❑e-mont❑ period or, if tE-e first or <br />last consecEliC:o period is less tin twelEo montE8, <br />to s❑c❑ period of less tin twelEo montE8, in tE-e <br />same manner as if a separate policy Elad ❑een <br />written for eac❑consecEliC:o period. <br />Statutory Provision. Yoh employee Eas a first <br />lien !won any amoEint wJc❑ Flecomes owing to yo❑ <br />❑y ::8 on acco::nt of tits policy, and in t0e case of <br />yo:lr legal incapacity or inai lity to receiC:o t!Da <br />money and pay it to t0b claimant, we will pay it <br />directly to t!-le claimant. <br />Part Fi!EO, " PremiE n", E, "Final PremiiE n", is <br />amended to read as follows❑ <br />T❑e premi::n siEown on t!-la Information Page, <br />scDed�es, and endorsements is an estimate. T❑e <br />final premiErn will !Da determined after tiffs policy <br />ends ❑y ring tEa act -al, not t!-le estimated, <br />premi�n psis and tDO proper classifications and <br />rates t❑at lawf:lly apply to t❑e ❑❑siness and wor❑ <br />cored ❑y tips policy. If tip final premi❑m is more <br />tiEan tip premi::n yo❑ paid to ice, yo❑ mi—st pay ::8 <br />t0e glance. If it is less, we will refEnd t:1e :1lance <br />to yo:1 TCe final premi::n will not Da less t:an t e <br />JgElest minimiEn premiiErn for t0a classifications <br />cored Dy tips policy. <br />If tEJs policy is canceled, final premiErn will ❑e <br />determined in t❑e following way ❑mess oFir manDals <br />prodde ot❑arwise❑ <br />a. If we cancel, final premiErn will ❑e calcL]ated pro <br />rata used on t❑a time tEJs policy was in force. <br />Final premiErn will not ❑e less tin t❑e pro rata <br />si:are of t!Da minim:ln premi:ln. <br />:1 If yo❑ cancel, final premi:ln may 00 more ti n <br />pro rata❑it will !Da :lased on t0a time tiJs policy <br />was in force, and may Da increased ❑y o:lr <br />smart -rate cancelation taEle and proced:lre. <br />Final premiErn will not 00 less tFlan t0a pro rata <br />stare of t!Da minim:ln premi:ln. <br />It is fiErt:ler agreed t❑at tiffs policy, incl❑ding all <br />endorsements forming a part t:lereof, constitEtes tEe <br />entire contract of ins:l-ance. ❑o condition, prodsion, <br />agreement, or iEnderstanding not set fort❑ in tEJs policy or <br />sue❑ endorsements sell affect sue❑ contract or any <br />rigs, dries, or priijleges arising ti—erefrom. <br />Form WC 04 03 01 BB Printed in❑.S.A. Page 2 of 2 <br />