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WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 06 10 (B) <br />POLICY NUMBER: UB-B9717817 <br />AMENDED CANCELLATION CONDITION ENDORSEMENT <br />The following modifies PART SIX – CONDITIONS, D. Cancellation, Paragraph 2., or any endorsement forming a <br />part of this policy that amends such condition: <br />If we cancel or do not renew this policy, we will mail or deliver to you written notice stating when such cancellation <br />or nonrenewal is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the <br />Information Page will be sufficient to prove notice. We will mail or deliver that notice: <br />a.At least ten days before the effective date of the cancellation or nonrenewal, if we cancel or do not renew for <br />nonpayment of premium; or <br />b.At least the number of days shown in the Schedule before the effective date of the cancellation or <br />nonrenewal, if we cancel or do not renew for any other reason. <br />Notwithstanding the provisions above, in no event will the number of days advance notice for cancellation or <br />nonrenewal be fewer than the number of days required by applicable law. <br />SCHEDULE <br />NUMBER OF DAYS 30 <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Endorsement Effective 12/9/2025 Policy No. UB-B9717817 Endorsement No. 2 <br />Insured PFM II, LLC Premium $ <br />Insurance Company Travelers Casualty and Surety Company A Stock Company <br />Countersigned by <br />Attachment Code: D682500 Master ID: 1529369, Certificate ID: 19861348 <br />Docusign Envelope ID: 458D6D02-0D6B-8C4E-8292-D706A4D93B4D