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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 07 E <br /> (Ed. 0 1-22) <br /> CALIFORNIA CANCELLATION 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 /> Cancellation: <br /> 1. You may cancel this policy.You must mail or deliver advance written notice to us stating when the cancellation is to take <br /> 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. Non-payment of deductible billing; <br /> d. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; <br /> e. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any <br /> previous policy issued by us; <br /> f. Material misrepresentation made by you or your agent; <br /> g. Failure to cooperate with us in the investigation of a claim; <br /> h. Material failure to comply with Federal or State safety orders; <br /> i. Material failure to comply with written recommendations of our designated loss control representatives; <br /> j. The occurrence of a material change in the ownership of your business; <br /> k. The occurrence of any change in your business or operations that materially increases the hazard for frequency or <br /> severity of loss; <br /> I. The occurrence of any change in your business or operation that requires additional or different classification for <br /> premium calculation; <br /> m. 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 (g),we will give you 10 days advance written notice, <br /> stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the <br /> Information Page will be sufficient to provide notice. If we cancel your policy for any of the reasons listed in Items (h)through <br /> (m),we will give you 30 days advance written notice; however,we agree that in the event of cancellation and reissuance of <br /> a policy effective upon a material change in ownership or operations, notice will not be provided. <br /> 4. If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 <br /> days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing <br /> address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. <br /> 5. The policy period will end on the day and hour stated in the cancellation notice. <br /> 6. A short rate penalty applies if you cancel this policy or if we cancel due to non-payment of premium, failure to report <br /> payroll, or non-payment of deductible billing. First, the standard premium, defined as the base premium (computed in <br /> accordance with Part 1, Section 2, Subsection 2 of the WCIRB's California Basic Underwriting Manual) adjusted for the <br /> experience modification factor and all other pricing factors except for premium discount and expense constant, will be <br /> multiplied by the quotient of the number of days for which the policy was written divided by the number of days the policy <br /> remained in force to produce the full standard premium.Second,the extended number of days will be determined by dividing <br /> the number of days the policy was in force by the number of days for which the policy was written and multiplying the quotient <br /> by 365 days. When the policy is written for a one-year period, the extended number of days will equal the number of days <br /> the policy remained in force.Third,the short rate percentage corresponding to the extended number of days will be obtained <br /> from the short rate cancellation table. Fourth,the short rate premium will be equal to the product of the full standard premium <br /> times the short rate percentage. The short rate table below will be used in computing the short rate premium. In no event <br /> will the final earned premium be less than the policy minimum premium. <br /> WC 99 06 07 E Page 1 of 2 <br /> (Ed. 01-22) <br />