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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 B <br /> (Ed.01-22) <br /> CALIFORNIA CANCELATION ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A.of the Information <br /> Page. <br /> The cancelation condition in Part Six(Conditions)of the policy is replaced by these conditions: <br /> Cancellation: <br /> 1. You may cancel this policy.You must mail or deliver advance written notice to us stating when the cancelation is to take <br /> effect. <br /> 2. We may cancel this policy for one or more of the following reasons: <br /> a. Non-payment of premium; <br /> b. Failure to report payroll; <br /> c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; <br /> d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any <br /> previous policy issued by us; <br /> e. Material misrepresentation made by you or your agent; <br /> f. Failure to cooperate with us in the investigation of a claim; <br /> g. Material failure to comply with federal or state safety orders or written recommendations of our designated loss control <br /> representatives; <br /> h. The occurrence of a material change in the ownership of your business; <br /> i. The occurrence of any change in your business or operations that materially increases the hazard for frequency or <br /> severity of loss; <br /> j. The occurrence of any change in your business or operation that requires additional or different classification for <br /> premium calculation; <br /> k. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance <br /> treaties. <br /> 3. If we cancel your policy for any of the reasons listed in (a)through (f),we will give you 10 days advance written notice, <br /> stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the <br /> Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items(g)through <br /> (k),we will give you 30 days advance written notice; however,we agree that in the event of cancelation and reissuance of a <br /> policy effective upon a material change in ownership or operations, notice will not be provided. <br /> 4. If we mail the notice to you,the stated periods of notice and your right to remedy the condition will be extended by 5 days if <br /> the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is <br /> outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. <br /> 5. The policy period will end on the day and hour stated in the cancelation notice. <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 Policy No. Endorsement No. <br /> Insured Insurance Company <br /> Countersigned By <br /> WC 04 06 01 B <br /> (Ed. 01-22) <br />