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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 21 <br /> ( Ed . 1 -08 ) <br /> OPTIONAL PREMIUM INCREASE ENDORSEMENT — CALIFORNIA <br /> You must provide us , or our authorized representative , access to records necessary to perform a payroll verification audit. If you <br /> fail to provide access within 90 days after expiration of the policy , you are liable to pay a total premium equal to 3 times our current <br /> estimate of the annual premium for your policy. In addition , if you fail to provide access after our third request within a 90 day or <br /> longer period , you are also liable for our costs in attempting to perform the audit unless you provide a compelling business reason <br /> for your failure . <br /> We will contact you to schedule appointments during normal business hours . <br /> We will notify you of your failure to provide access by mailing a certified , return-receipt document stating the increased premium <br /> and the total amount of our costs incurred in our attempt(s) to perform an audit. In addition to any other obligations under this <br /> contract, 30 days after you receive the notification , you will be obligated to pay the total premium and costs referenced above. If, <br /> thereafter, you provide access to your records within three years after the policy expires , or within another mutually agreed upon <br /> time , and we succeed in performing the audit to our satisfaction , we will revise your total premium and the costs due to reflect the <br /> results of the audit. <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 12/11 /2021 Policy No . WWC3560056 Endorsement No . 0 <br /> Insured Tank-Tight Systems Inc Premium $ 10 , 588 <br /> Insurance Company Wesco Insurance Company <br /> Countersigned by <br /> WC 04 04 21 <br /> ( Ed . 1 -08) <br /> © Copyright 2007 National Council on Compensation Insurance , Inc . All Rights Reserved . <br />