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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 0406 01 A WC380497004 10/1/2025 CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the information page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancellation 1. The occurrence of a material change in the 1. You may cancel this policy. You must mail or deliv- ownership of your business; er advance written notice to us stating when the j, The occurrence of any change in your busi- cancelation is to take effect. ness or operations that materially increases the Z We may cancel this policy for one or more of the hazard for frequency or severity of loss; following reasons: k. The occurrence of any change in your busi- a. Non-payment of premium; ness or operation that requires additional or b. Failure to report payroll; different classification for premium calculation; c. Failure to permit us toaudit payroll as required L The occurrence of any change in your busi- by the terms of this policy or of a previous ness or operation which contemplates an activ- policy issued by us; ity excluded by our reinsurance treaties. d. Failure to pay any additional premium resulting 3. If we cancel your policy for any of the reasons from an audit of payroll required by the terms listed in (a) through {f}, we will give you 10 days of this policy or any previous policy issued by advance written notice, stating when the cancel- us; ation is to take effect. Mailing that notice to you at e, Material misrepresentation made by you or your mailing address shown in item 1 of the Infor- yaur agent; mation Page will be sufficient to prove notice_ If we cancel your policy for any of the reasons listed in f. Failure to cooperate with us in the investigation items (g) through (I), we will give you 34 days of a claim; advance written notice; however, we agree that in g. Failure to comply with Federal or State safety the event of cancelation and reissuance of a policy orders; effective upon a material change in ownership or operations, notice will not be provided. h. Failure to comply with written recommen- dations of our designated loss control repre- 4. The policy period will end on the day and hour sentatives; stated in the cancelation notice, 86556008 I VEANPLU-M 1 25-26 WC Master I Nancy Cadava Llader ; 8/29/2C25 11:03:33 AM (PST( Page 3 of 3