Laserfiche WebLink
Workers' Compensation and Employers' Liability Policy <br /> Named Insured <br /> TriNet Group,Inc.L/C/F PowerPivotPro LLC <br /> 1 Park Place,Suite 600 Endorsement Number <br /> Dublin,CA 94568-7983 <br /> Policy Number <br /> Symbol: WLR Number:C57632124 <br /> Policy Period Effective Date of Endorsement <br /> 07/01/2024TO 07/01/2025 07/01/2024 <br /> Issued By(Name of Insurance Company) <br /> ACE American Insurance Company <br /> Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> NOTICE TO OTHERS ENDORSEMENT - SPECIFIC PARTIES <br /> A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than <br /> nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or <br /> other form of notification as we determine, to the persons or organizations listed in the schedule set out below (the <br /> "Schedule"). You or your representative must provide us with both the physical and e-mail address of such persons or <br /> organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us <br /> on such Schedule. <br /> B. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each <br /> person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the <br /> Policy. <br /> C. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) <br /> named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any <br /> kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) <br /> or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or <br /> representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. <br /> D. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any <br /> incorrect information that you or your representative provide to us. If you or your representative does not provide us with <br /> the information necessary to complete the Schedule, we have no responsibility for taking any action under this <br /> endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information <br /> with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to <br /> such person or entity under this endorsement. <br /> E. We may arrange with your representative to send such notice in the event of any such cancellation. <br /> F. You will cooperate with us in providing, or in causing your representative to provide, the e-mail address and physical <br /> address of the persons or organizations listed in the Schedule. <br /> G. This endorsement does not apply in the event that you cancel the Policy. <br /> SCHEDULE <br /> Name of Certificate Holder E-Mail Address Physical Address <br /> City of Santa Ana Public Works Agency- 20 Civic Center Plaza(M-30),PO BOX <br /> Water Resources Division 1988 <br /> Santa Ana, CA 92702 <br /> All other terms and conditions of this Policy remain unchanged. <br /> This endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM, TX and WI. <br /> -- --- <br /> Authorized Representative <br /> WC 99 03 71 (01/11) Page 1 of 1 <br /> APPROVED <br /> By Cynthia Mora at 2:22 pm, Dec 04, 2024 <br />