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POLICY NO. :72SBAAC2429 it <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) <br /> This policy is subject to the following additional Conditions: <br /> A. If this policy is cancelled by the Company, other If notice is mailed, proof of mailing to the last known <br /> than for non-payment of premium, notice of such mailing address of the certificate holder(s) on file with <br /> cancellation will be provided at least thirty (30) days the agent of record or the Company will be sufficient <br /> in advance of the cancellation effective date to the proof of notice. <br /> certificate holder(s) with mailing addresses on file Any notification rights provided by this endorsement <br /> with the agent of record or the Company. apply only to active certificate holder(s)who were issued <br /> B. If this policy is cancelled by the company for non- a certificate of insurance applicable to this policy's term. <br /> payment of premium, or by the insured, notice of Failure to provide such notice to the certificate holder(s) <br /> such cancellation will be provided within ten (10) will not amend or extend the date the cancellation <br /> days of the cancellation effective date to the becomes effective, nor will it negate cancellation of the <br /> certificate holder(s) with mailing addresses on file policy. Failure to send notice shall impose no liability of <br /> with the agent of record or the Company. any kind upon the Company or its agents or <br /> representatives. <br /> Form SS 12 23 0611 Page 1 of 1 <br /> © 2011,The Hartford <br /> 85027131 24-25 CA GL-KNGA-WC-PL Shenk YoUng 4/28/2025 2:20:10 PM (PbT) I Page A5 of 18 <br />