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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POCKY • •• • •• • •-~ • ~- • ~• • <br />Insured Name: Walker Automotive Supply Inc <br />Policy Number: 010-WC11A-63179 • <br />Agency Name: 4054, Wells Fargo Ins Svcs USA InclCharlotte <br />AMENDED NOTICE OF CANCELLATION PROV[DED BY US <br />Th(s endorsement modifies insurance prvvtded under the following: <br />WORKERS' COMPENSATION AND EMPLOYERS LlASILITY INSURANCE POt_iCY <br />Schedule <br />A. Number of Days' Notice 30 <br />B. Person{s} yr Organization Name and Address <br />Orange County <br />Attn: Jeffery Thompson <br />PO Box 8181 <br />Hillsborough, NC. 27278 <br />(If no entry appears above, information required to complefa this Scheduie will be shown in the <br />Declarations as applicable to the endorsement.} <br />For any sta#utorfly permitted reason other than nonpayment of pram€um, the number of days <br />required for notice of cancellation fo the insured first named in item 1, as provided In Paragraph D. <br />of either the CANCELLATION Condition or as amended by an applicable state cancellation <br />endorsement, is increased to the number of days shown in item A. in the <br />Schedule above. <br />When a parson or organization is listed in Item B. in the Scheduie above, the number of days notice <br />in Item A. also applies to the person(s) or organization fisted in the Schedule above. <br />This endorsement changes the policy to which it is attached and is effective on the date Issued unless <br />otherwise stated. <br />Issued by: National Trust insurance Company - 27367 <br />Errdarsement Number: • <br />Effective Dafe: 3/31/14 Date issued: 3/31! 14 /"j <br />Countersigned by "~°`Jc/ <br />Au#horized Representative <br />INC 99 06 11 A (Eff. 07109) <br />Includes copyrighted material of the National Ceuncil on Compensa#lon Insurance, Inc. used with its permission. <br />