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........................................................................................................................................................................................................................................................................................................................................................................................................................................................ <br />111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 <br />WC 04 06 01 BWORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />(Ed. 01-22) <br />CALIFORNIA CANCELATION ENDORSEMENT <br />.A. of theThis endorsement applies only to the insurance provided by the policy because California is shown in Item 3 <br />Information Page. <br />The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: <br />Cancelation: <br />he cancelation is to1. You may cancel this policy. You must mail or deliver advance written notice to us stating when t <br />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 />ed by us;c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issu <br />icy ord. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this pol <br />any previous 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 />ignatedg. Material failure to comply with federal or state safety orders or written recommendations of our des <br />loss control representatives; <br />h. The occurrence of a material change in the ownership of your business; <br />i. The occurrence of any change in your business or operations that materially increases the hazard for <br />frequency or severity of loss; <br />ationj. The occurrence of any change in your business or operation that requires additional or different classific <br />for premium calculation; <br />ed by ourk. The occurrence of any change in your business or operation which contemplates an activity exclud <br />reinsurance treaties. <br />e written3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advanc <br />address shown innotice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing <br />or any of the reasonsItem 1 of the Information Page will be sufficient to prove notice. If we cancel your policy f <br />t in the eventlisted in Items (g) through (k), we will give you 30 days advance written notice; however, we agree tha <br />s, notice willof cancelation and reissuance of a policy effective upon a material change in ownership or operation <br />not be provided. <br />will be extended by4. If we mail the notice to you, the stated periods of notice and your right to remedy the condition <br />ling or your5 days if the place of mailing and your mailing address is within California, 10 days if the place of mai <br />tside of themailing address is outside of California and 20 days if the place of mailing or your mailing address is ou <br />United States. <br />5. The policy period will end on the day and hour stated in the cancelation notice. <br />he date issued unless otherwise stated.This endorsement changes the policy to which it is attached and is effective on t <br />ent to preparation of the policy.)(The information below is required only when this endorsement is issued subsequ <br />W23-A427457-12EndorsementEffective Policy No. <br />Insured <br />ALLMERICA FINANCIAL BENEFIT INSURANCEInsurance Company <br />Endorsement No. <br />Countersigned By <br /> <br />WC 04 06 01 B <br />(Ed. 01-22) <br />Docusign Envelope ID: D61C24C1-1EEB-4464-8CDF-5C4CE6FD0AB4