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Dallas, TX 1-866-519-2522 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />(Ed. 4-15) <br />WC 99 06 18 <br />AMENDMENT – 30 DAY NOTICE OF CANCELLATION FOR THIRD PARTIES <br />We agree to give thirty (30)days’notice of cancellation to the following certificate holder(s)in the event that <br />we cancel the policy for any reason other than non-payment of premium: <br />SCHEDULE <br />We will endeavor to provide advice of cancellation (the “Advice”)to the certificate holders listed in the schedule <br />by e-mail.Certificate holders include only those entities for which thirty (30)days’notice of cancellation is <br />required by an “insured contract”but only with respect to an entity for which you are directly or indirectly <br />performing your work. <br />This advance notification of a pending cancellation of coverage is intended as a courtesy only.Our failure to <br />provide such Advice will neither extend the policy cancellation nor negate cancellation of the policy;nor will <br />such failure result in obligation or liability of any kind upon us, our agents or representatives. <br />This endorsement does not affect,in any way,coverage provided under this policy,the cancellation of this <br />policy or the effective date of cancellation. <br />Where required by Written Contract. <br />Endorsement No.: <br />Insurance Company:Countersigned by: <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 />Copyright © Starr Indemnity & Liability Company. All rights reserved. <br />002 <br />STARR INDEMNITY & LIABILITY CO <br />WC 99 06 18 <br />(Ed. 4-15)Page 1 of 1 <br />Policy No.:100 0005190Endorsement Effective:12/08/2024 <br />Insured:Duke's Root Control, Inc. <br />Docusign Envelope ID: 1A791935-55C3-4976-BEBF-1D6F49DE749D