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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 20 74 <br />(Ed. 12-16) <br />NOTICE OF CANCELLATION TO THIRD PARTIES <br />A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or <br />organizations shown in the Schedule below by email as soon as practical after notifying the first Named <br />Insured. <br />B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. <br />Our failure to provide such advance notification will not extend the policy cancellation date nor negate <br />cancellation of the policy. <br />Name of Other Person(s) / Organization(s): <br />As required by written contract <br />or written agreement <br />SCHEDULE <br />30 Days <br />All otherterms and conditions of this policy remain unchanged. <br />Issued by <br />For attachment to Policy No. WA7-64D-444950-019 Effective Date 6/01/2019 Premium $ <br />Issued to <br />