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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 990662 <br />NOTICE OF CANCELLATION OR NON -RENEWAL TO SPECIFIED PERSONS OR <br />ORGANIZATIONS <br />This endorsement changes the policy to which R is attached and is effective on the date issued unless <br />otherwise stated. <br />This endorsement effective on <br />Policy No. 64309538 <br />101112021 <br />(DATE) <br />Issued to Macro-Z Technology Company <br />of the <br />at 12:01 A M. standard time, forms a part of <br />The following Condition is added to PART SIX -CONDITIONS: <br />Federal Insurance Company <br />(NAME OF INSURANCE COMPANY) <br />Authorized Representative <br />Notice Of Cancellation Or Non -Renewal To Specified Persons Or Organizations <br />I. If we cancel or non -renew this policy for any reason other than non-payment, we will deliver notice of <br />the cancellation or non -renewal to any Person(s) or Organization(s) shown in the Schedule <br />THIRTY (30) days prior to the effective data of cancellation or non -renewal. <br />2. If we cancel -this policy for non-payment, we will deliver notice of the cancellation to any Person(s) or - <br />Organization(s) shown in the Schedule TEN (10) days prior to the effective <br />date of cancellation. <br />3 If notice is mailed, proof of mailing will be sufficient proof of notice. <br />4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or <br />non -renewal with respect to any other person(s) or organization(s). <br />SCHEDULE <br />Name (s) and Address (es): <br />ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH <br />u5 <br />wn 99 06 62(Ed. 01.16) <br />