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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 />Endorsement Effective 12-18-24 Policy No. 71815616 Endorsement No. <br />Insured TRB AND ASSOCIATES Premium $ Incl. <br />Insurance Company Chubb National Insurance Company <br />Countersigned By <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 B <br />(Ed. 01-2022) <br />WC 04 06 01 B <br />(Ed. 01-22) <br />CALIFORNIA CANCELATION ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information <br />Page. <br />The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: <br />Cancelation: <br />1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to 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 />c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; <br />d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous <br />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 />g. Material failure to comply with federal or state safety orders or written recommendations of our designated loss control <br />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 frequency or severity <br />of loss; <br />j. The occurrence of any change in your business or operation that requires additional or different classification for premium <br />calculation; <br />k. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance <br />treaties. <br />3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating <br />when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information <br />Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (k), we will give <br />you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective <br />upon a material change in ownership or operations, notice will not be provided. <br />4. If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the <br />place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside <br />of California and 20 days if the place of mailing or your mailing address is outside of the United States. <br />5. The policy period will end on the day and hour stated in the cancelation notice. <br />Insured Copy <br />Docusign Envelope ID: F709D17A-8DCE-46EE-8D56-94BE21810E02