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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 A <br /> ( Ed . 12 -93 ) <br /> CALIFORNIA CANCELATION ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because California is shown in Item 3 . A. of the Information <br /> Page. <br /> The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions : <br /> Cancelation <br /> 1 . You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take 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. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us ; <br /> d . Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous <br /> policy issued by us ; <br /> e. Material misrepresentation made by you or your agent; <br /> f. Failure to cooperate with us in the investigation of a claim ; <br /> g . Failure to comply with Federal or State safety orders ; <br /> h . Failure to comply with written recommendations of our designated loss control representatives ; <br /> i . The occurrence of a material change in the ownership of your business ; <br /> j . The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity <br /> of loss ; <br /> k. The occurrence of any change in your business or operation that requires additional or different classification for premium <br /> calculation ; <br /> I . The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance <br /> treaties . <br /> 3 . If we cancel your policy for any of the reasons listed in (a) through (f) , we will give you 10 days advance written notice , stating <br /> when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information <br /> Page will be sufficient to prove notice . If we cancel your policy for any of the reasons listed in Items (g ) through (1 ) , we will give <br /> you 30 days advance written notice ; however, we agree that in the event of cancelation and reissuance of a policy effective <br /> upon a material change in ownership or operations , notice will not be provided . <br /> 4 . The policy period will end on the day and hour stated in the cancelation notice . <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 /> WC040601A <br /> ( Ed . 12-93) <br /> © Copyright 2011 by The Workers' Compensation Insurance Rating Bureau of California . All rights reserved . <br /> From the WCIRB 's California Workers ' Compensation Insurance Forms Manual Copyright 1999 . <br />