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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED <br /> WC 00 00 00 C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> (Ed. 1-15) <br /> PART SIX If you die and we receive notice within thirty days after <br /> CONDITIONS your death,we will cover your legal representative as <br /> insured. <br /> A, Inspection <br /> Cancelation <br /> We have the right, but are not obliged to inspect <br /> your workplaces at any time. Our inspections are 1. You may cancel this policy. You must mail or <br /> not safety inspections. They relate only to the deliver advance written notice to us stating when <br /> insurability of the workplaces and the premiums to the cancelation is to take effect. <br /> be charged. We may give you reports on the 2. We may cancel this policy, We must mail or <br /> conditions we find. We may also recommend deliver to you not less than ten days advance <br /> changes.While they may help reduce losses, we written notice stating when the cancelation is to <br /> do not undertake to perform the duty of any person take effect. Mailing that notice to you at your <br /> to provide for the health or safety of your mailing address shown in Item 1 of the Information <br /> employees or the public. We do not warrant that Page will be sufficient to prove notice. <br /> your workplaces are safe or healthful or that they 3. The policy period will end on the day and hour <br /> comply with laws, regulations, codes or standards. stated in the cancelation notice. <br /> Insurance rate service organizations have the <br /> 4. Any of these provisions that conflict with a law that <br /> same rights we have under this provision. controls the cancelation of the insurance in this <br /> B. Long Term Policy policy is changed by this statement to comply with <br /> the law. <br /> If the policy period is longer than one year and <br /> E. Sole Representative <br /> sixteen days, all provisions of this policy will apply <br /> as though a new policy were issued on each The insured first named in Item 1 of the Information <br /> annual anniversary that this policy is in force. Page will act on behalf of all insureds to change this <br /> policy, receive return premium, and give or receive <br /> C. Transfer of Your Rights and Duties notice of cancelation. <br /> Your rights or duties under this policy may not be <br /> transferred without our written consent. <br /> 10 of 24 <br /> Ed.1-15 <br /> ©Copyright 2013 National Council on Compensation Insurance,Eno All Rights Reserved, <br /> it <br />