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............................................................................................................................................................................................................................................................................................................................. <br />.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... <br />W23A427457 1001678 <br />WC 02 06 01 CWORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />(Ed.09-2021) <br />Arizona Cancellation and Nonrenewal Endorsement <br />on Page.This endorsement applies because Arizona is shown in Item 3.A. of the Informati <br />he following:Part Six--Conditions, Section D. (Cancellation) of the policy is replaced by t <br />D.Cancellation and Nonrenewal <br />g when1. You may cancel this policy. You must mail or deliver advance written notice to us statin <br />the cancellation is to take effect. <br />ommission of2. If you cancel or fail to renew this policy, we must promptly notify the Industrial C <br />Arizona. <br />oth of the parties3. We may cancel this policy if you fail to pay premium when due, or when one or b <br />to a professional employer agreement terminate the agreement. <br />If we cancel or nonrenew this policy, we must provide to you and the Industrial <br />Commission of Arizona at least 30 days’ notice of the cancellation or nonrenewal. <br />Notice to you may be sent via mail or delivered by electronic means as follows: <br />Mailing that notice to you at your last-known mailing address on file with us will be <br />sufficient proof of notice. <br />ocuments.Delivery to an email address at which you have consented to receive notices or d <br />Posting on a portal, secure website, electronic network or site accessible via the <br />ectronicInternet or a mobile application, computer, mobile device, tablet, or other el <br />ment ordevice, together with a separate notice that includes a description of the docu <br />notice that was posted and that was provided by email to the email address at which <br />you consented to receive notice, or by any other delivery method to which you <br />consented. <br />ling thatIf you consented to have the notice emailed in accordance with Arizona law, emai <br />ufficientnotice to you at your last-known email address as provided by you to us will be s <br />proof of notice. <br />ecomeIf the email notice is: (1) rejected for delivery; (2) returned to us; or (3) we b <br />aware that the email address provided by you is no longer valid, then we will also <br />mail that notice to you by US Postal Service certified mail, certificate of mailing, or <br />od usedfirst-class mail using intelligent mail barcode, or another similar tracking meth <br />or approved by the US Postal Service. <br />will notIf we nonrenew this policy and fail to give you notice of nonrenewal, coverage <br />extend beyond the policy period. <br />enewal notice.4. The policy period will end on the date and time stated in the cancellation or nonr <br />f the insurance in this5. Any of these provisions that conflict with a law that controls the cancellation o <br />policy is changed by this statement to comply with the law. <br />otherwise stated.This endorsement changes the policy to which it is attached and is effective on the date issued unless <br />e policy.)(The information below is required only when this endorsement is issued subsequent to preparation of th <br />Policy No.Endorsement No.Endorsement Effective <br />Insured <br />Insurance Company <br />WC 02 06 01 C <br />(Ed. 09-2021) <br />Premium <br />Countersigned by <br />1of1 <br />Copyright 2021 National Council on Compensation Insurance, Inc. All Rights Reserved. <br />W23A42745712 <br />ALLAMERICA FINANCIAL BENEFIT INSURANCE <br />Docusign Envelope ID: F111E3DB-87BF-83BA-82F6-49452934899E