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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 <br /> (Ed.1-01) <br /> PREMIUM DUE DATE ENDORSEMENT <br /> This endorsement is used to amend: <br /> Section D.of Part Five of the policy is replaced by this provision. <br /> PART FIVE PREMIUM <br /> 1D. Premium is amended to read: <br /> You will pay all premium when due.You will pay the premium even if part or all of a workers compensation law is not <br /> valid. The due date for audit and retrospective premiums is the date of the billing. <br /> 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 02/08/2017 Policy No, MWC0106102-01 Endorsement No. <br /> insured: Senior Care of Orange County Inc Premium(See Attached) <br /> Insurance Company: Markel Insurance Company Countersigned by <br /> WC000419 <br /> Ed.1-01 <br /> 02000 National Council on Compensation Insurance,Inc. <br /> 15 of 24 <br />