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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> NOTICE OF CANCELLATION-CERTIFICATE HOLDERS <br /> WORKERS COMPENSATION <br /> The person(s) or organization(s) listed or described in the Schedule below have requested that they receive <br /> written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or <br /> Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to <br /> you. Such copies of the notice will be mailed as soon as practicable to the address or addresses provided by <br /> your broker or agent. <br /> This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such <br /> notification to the person(s)or organization(s) shown in the Schedule will not extend any policy cancellation date <br /> nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or <br /> organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. <br /> Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the <br /> Schedule below will not impose liability of any kind upon us. <br /> Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this <br /> endorsement is changed by this statement to comply with the law. <br /> SCHEDULE <br /> Person(s)or Organization(s) including mailing address: <br /> Per the listing of certificate holders provided by the Broker upon our request. 30 day notice of cancellation <br /> applies <br /> All other terms and conditions of this policy remain unchanged. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 07/01/2025 Policy No. 9016877001 Endorsement No. <br /> Insured Premium: <br /> Insurance Company Countersigned by <br /> WC 99 06 72 (Ed.0911) Page 1 of 1 <br /> 9016877 06123l2023 <br /> Sentry Casualty Company <br /> 1 00002 0000000000 23174 0 N 66bda496-c32&49ad-95ff-c007362d2ce2 <br />