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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />EEC Environmental WC 04 06 01 A <br />dba Enviromental Engineering Contracting Inc:, (Ed. 12J 93) <br />WCA2008 $1 S 17 <br />CALIFORNIA CANCELATION ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A, of the <br />INFORMATION PAGE. <br />The cancellation condition in Part Six (Conditions) of the policy is replaced by these conditions: <br />CANCELATION <br />1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is <br />to take effect. <br />2. We may cancel this policy for one or more of the following reasons: <br />a. Non-payment of premium; <br />b. Failure to report payroll; <br />c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; <br />d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or <br />any previous policy issued by us; <br />e. Material misrepresentation made by you or your agent; <br />f. Failure to cooperate with us in the investigation of a claim; <br />g. Failure to comply with Federal or State safety orders; <br />h. Failure to comply with written recommendations of our designated loss control representatives; <br />i, The occurrence of a material change in the ownership of your business; <br />j. The occurrence of any change in your business or operations that materially increases the hazard for <br />frequency or severity of loss; <br />k. The occurrence of any change in your business or operation that requires additional or different classification <br />for premium calculation; <br />Copyright 1998by The Workers' Compensadon Insurance Rating Bureau of California. WI rights reserved. <br />From the WCIRB's California Workers$ Compensation Insurance Forms Manual Copyright 10, <br />INSURED <br />58383173 120-21 G/A/VMB/POLL/B&D/WC I Jennifer Barton i 10/30/2020 1:48:06 PM (PDT) I page 11 of 11 <br />a5 °raklc 1�8�C�1'i8}C}pC17t i)(Y�8I01L <br />REVIEWED & APPitavm 8Y. <br />Mir f4o*aw k. <br />Ris.R4lanAQeneFEtldnal�st <br />