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CALIFORNIA CANCELLATION ENDORSEMENT <br />GRANITE STATE INSURANCE COMPANY <br />Insured: Bender Rosenthal, Inc. <br />Insurer: Granite State insurance Company, an AIG company <br />Policy Number: WC 019-39-7574 <br />Policy Effective Date: 06/01/2017 <br />This endorsement changes the policy to which it is attached effective on the <br />inception date of the policy unless a different date is indicated below. <br />This endorsement, effective 12:01 AM 06/01/2017 forms a part of Policy No. WC <br />019-39-7574 <br />Issued to BENDER ROSENTHAL, INC. <br />By: GRANITE STATE INSURANCE COMPANY <br />We have a right to recover our payments from anyone liable for an injury covered <br />by this policy. We will not enforce our right against any person or organization <br />with whom you have a written contract that requires you to obtain this agreement <br />from us, as regards any work, you perform for such person or organization. <br />The additional premium for this endorsement shall be 2.00% of the total estimated <br />workers' compensation premium for this policy. <br />WC 04 03 61 Countersigned b <br />(Ed. 11/90) Authorized Representative <br />1A <br />REVIEWED BY: EUNICE FIEREDA (Po 6OF <br />