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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 01 10 <br />(Ed. 1/08) <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />EARLIER NOTICE OF CANCELLATION PROVIDED BY US ENDORSEMENT <br />This endorsement modifies Insurance provided under the following: <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />Number of Days Notice: 30 <br />(If no entry appears above, information required to complete this Schedule will be shown in the <br />Declarations as applicable to this endorsement.) <br />For any statutorily permitted reason other than nonpayment of premium, the number of days required for <br />notice of cancellation, as provided in PART SIX — CONDITIONS, D. Cancellation of the Workers' <br />Compensation and Employers' Liability Insurance Policy or as amended by an applicable state cancellation <br />endorsement, is increased to the number of days shown in the Schedule above <br />All other terms and conditions remain the same. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless <br />otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the <br />policy.) <br />Endorsement Effective Policy No. Endorsement No <br />Insured: XL Specialty Insurance Company CWG740901501 <br />Countersigned by <br />WC 9901 10 <br />Ed. 1/08 2007 XL America, Inc. <br />