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WORKERS COMPENSATION <br /> AND EMPLOYERS LIABILITY POLICY <br /> ENDORSEMENT WC 99 06 11 (A) <br /> POLICY NUMBER: <br /> TC2KUB-131 J374-2-12(AOS) <br /> TRJ-UB-13 1 J3 846(AZ,OR,WI) <br /> NOTICE OF CANCELLATION <br /> Except for non-payment of premium by you,we agree that no cancellation or limitation of this policy <br /> shall become effective until the number of day's written notice specified in item 2 of the schedule has <br /> been mailed to you to the person or organization designated in item 1 of the schedule at the address <br /> indicated. <br /> SCHEDULE <br /> 1. Name: any person or organization to whom you have agreed in a written contract that <br /> notice of cancellation or material limitation of this policy will be given, but only if: <br /> • You send us a written request to provide such notice, including the name and <br /> address of such person or organization, after the first named insured received <br /> notice from us of the cancellation or material limitation of this policy; and <br /> • We receive such written request at least 14 days before the beginning of the <br /> applicable number of days shown in this schedule. <br /> Address: The address for that person or organization included in such written request <br /> from you to us. <br /> 2. Number of days written notice: 30 additional days <br /> This endorsement changes the policy to which it is attached and is effective on the date issued <br /> unless otherwise stated. <br /> Miscellaneous Attachment:M463692 <br /> Certificate ID : 11963585 <br />