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CALIFORNIA CANCELLATION ENDORSEMENT <br />GRANITE STATE INSURANCE COMPANY <br />Insured: Bender Rosenthal, Inc. <br />Policy Number: WC 019-39-7574 <br />Policy Effective Dates: 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 />This endorsement applies only to the insurance provided by the policy because <br />California is shown in Item 3.A. of the information Page. <br />The cancellation condition in Part Six (Conditions)of the policy is replaced by <br />these conditions: <br />Cancellation <br />1. You may cancel this policy. You must mail or deliver advance written notice <br />to us stating when the 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 this <br />policy or of a previous policy issued by us; <br />d) Failure to pay any addition premium resulting from an audit of payroll <br />required by the terms of this policy or any previous policy issued by us; <br />e) Material misrepresentation made by you or your agent; <br />0 Failure to cooperated with us in the investigation of a claim; <br />REVIEWED BY: EUNIGE tVEREDIR PG ` OF ) <br />