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THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />CALIFORNIA AMENDATORY ENDORSEMENT <br />This endorsement modifies insurance provided under the following: <br />SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />I. PART FOUR • VOLUNTARY COMPENSATION AND EMPLOYERS LIABILITY COVERAGE, D. <br />Our Reimbursement is deleted in its entirety and replaced with the following: <br />D. Our Reimbursement <br />Before we will reimburse you for the amount equal to the benefits that is excess of Your <br />Retained Limit, the claimants must: <br />1. Transfer to us the claimant's right to recover from others who may be responsible for the <br />injury or death; and <br />2. Cooperate with us and do everything necessary to enable us to enforce the right of <br />recovery from others. <br />If the persons entitled to the benefits fail to do these things, our duty to reimburse ends at once. <br />If they claim damages from us for the injury or death, our duty to reimburse ends at once. <br />II. PART NINE — CONDITIONS, Condition K. Cancellation or Non - renewal is deleted in its entirety <br />and replaced with the following: <br />K. Cancellation <br />1. You may cancel this policy. You must mail or deliver advance notice to us stating when the <br />cancellation is to take 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 the policy or of a previous <br />policy issued by us; <br />d. to pay any additional premium as a result of a audit of payroll as required by the terms of the <br />policy or of a previous policy issued by us <br />e. Material misrepresentation made by you or your agent; <br />Endorsement Number: 4 <br />Policy Number: WCX 0055277 00 <br />Named Insured: Western Orange County Self- Funded Workers' Compensation Agencv <br />This endorsement is effective on the inception date of this Policy unless otherwise stated herein: <br />Endorsement Effective Date: July 1. 2013 <br />00 GL0403 05 (01 08) Page 1 of 2 <br />