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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 A <br /> (Ed. 12-93) <br /> CALIFORNIA CANCELATION ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the <br /> Information Page. <br /> The cancelation condition in Part Six(Conditions)of the policy is replaced by these conditions: <br /> Cancelation: <br /> 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to <br /> 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 policy or of a previous policy issued by us; <br /> d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or <br /> any previous policy issued by us; <br /> e. Material misrepresentation made by you or your agent; <br /> f. Failure to cooperate with us in the investigation of a claim; <br /> g. Failure to comply with Federal or State safety orders; <br /> h. Failure to comply with written recommendations of our designated loss control representatives; <br /> i. The occurrence of a material change in the ownership of your business; <br /> j. The occurrence of any change in your business or operations that materially increases the hazard for frequency <br /> or severity of loss; <br /> k. The occurrence of any change in your business or operation that requires additional or different classification for <br /> premium calculation; <br /> I. The occurrence of any change in your business or operation which contemplates an activity excluded by our <br /> reinsurance treaties. <br /> 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written <br /> notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 <br /> of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items <br /> (g)through (1), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and <br /> reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. <br /> 4. The policy period will end on the day and hour stated in the cancelation notice. <br /> APPROVED <br /> By Cynthia Mora at 5:30 pm, Dec 02, 2024 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> This endorsement, effective at 12:01 AM standard time, forms a part of <br /> Policy No. Of the <br /> Carrier Code <br /> Issued to Endorsement No. <br /> Premium <br /> Countersigned at on By: <br /> Authorized Representative <br /> WC040601A <br /> (Ed. 12-93)©Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />