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CALIFORNIA ADVANCE NOTICE OF CANCELLATION OR NON-RENEWAL BY US EXTENDED <br /> This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a <br /> different date is indicated below. <br /> (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br /> This endorsement, effective 12:01 AM 03/01 /2024 forms a part of Policy No. WC 080-75-6387 <br /> Issued to GOFORTH & MARTI - DBA: GM BUSINESS INTERIORS <br /> By NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH, PA. <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> This endorsement modifies insurance provided under the following: <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> PART SIX- CONDITIONS, D. - Cancellation, 2. is deleted in its entirety and replaced with: <br /> We may cancel or non-renew this policy. We will mail or deliver to you not less than 10 days advance written notice of <br /> cancellation for reasons (a) through (g) and 30 days advance written notice of cancellation for reasons (h) through (m) <br /> of California Cancellation Endorsement WC990017. We will mail or deliver to you not less than 30 days and not more <br /> than 120 days advance written notice of non-renewal. <br /> Except for non-payment of premium and non-payment of loss reimbursement or non-delivery of satisfactory security or <br /> collateral when due, for which we will provide advance written notice in accordance with the provisions of any applicable <br /> statute or regulation, we shall not provide less than the number of days set forth below. <br /> Mailing that notice to you, at your mailing address shown in Item 1 of the Information Page will be sufficient to prove <br /> notice. <br /> Cancellation: 60 Days <br /> Non-Renewal: 60 Days <br /> o M ol _i Risk REVIEWED L/M ston <br /> REVI EWED&APPROVED SY. <br /> anima <br /> Risk Management Specialist <br /> WC 99 04 11 Countersigned by <br /> (Ed. 08/03) <br /> Authorized Representative <br />