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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 OB 01 A <br />EEC Environmental <br />dba Enviromental. Engineering Contracting Inc:, (Ed. 12J 93) <br />WCA2008 81 S 17 <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 cancellation 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 cancellation is <br />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 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 <br />frequency or severity of loss; <br />k. The occurrence of any change in your business or operation that requires additional or different classification <br />for premium calculation; <br />Copyright 1998by The Workers' Compensation Insurance Rating Bureau of Cafifomia. WI rights reserved. <br />From the WCIRB's California Workers' Compensation Insurance Forts Manual Copyright 199 <br />City Council INSURED 21 — 81 <br />58383173 120-21 G/A/UM9/P0LL/BOO/WC I .7ennifer 9arton i 10/30/2020 IABA6 PM (PDT) I page 7.1 of 11 <br />r"'RIA <br />Z PjSkMettaVxwdD[vbbn <br />REVIEWED & APPizavm 8Y. <br />� r tl, iFbe�6, <br />Risk ManalgertpQnt Anallpt <br />