Laserfiche WebLink
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 <br />policy.) <br />Insured <br />APT Advanced Polymer Technology Corporation <br />Policy No. <br />WC E658736 05 <br />Company <br />Great American Alliance Insurance Company <br />Effective Date Premium <br />$ <br />Endorsement No. <br />Authorized <br />Representative Aon Risk Services Central Inc <br /> <br />NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) <br />This policy is subject to the following additional Conditions: <br /> <br />A.If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will <br />be provided in accordance with state statutorily required number of days to the certificate holder(s) with mailing <br />addresses on file with the agent of record or the Company. <br /> <br />B.If this policy is cancelled by the Company for non-payment of premium, or by the insured, notice of such <br />cancellation will be provided in accordance with state statutorily required number of days to the certificate <br />holder(s) with mailing addresses on file with the agent of record or the Company. <br /> <br />If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent <br />of record or the Company will be sufficient proof of notice. <br /> <br />Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a <br />certificate of insurance applicable to this policy©s term. <br /> <br />Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes <br />effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon <br />the Company or its agents or representatives. <br />WC 98 06 46 (Ed. 06-14) <br />WC 98 06 46 (Ed. 06-14) <br />(Page 1 of 1) <br />R * SW * 01/07/2026 * WC E658736 05 00 Great American Alliance Insurance Company <br />*D/B* 894082973 107288 <br />Docusign Envelope ID: DAE6D8AF-BF69-4C23-B861-58AA0D8C544C