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NAMED INSURED: SEE ATTACHED CERTIFICATE <br /> ENDORSEMENT EFFECTIVE: 5/1/2016 <br /> POLICY NO: 90-17043-06 (HI) <br /> 90-17043-07 (AOS) <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> NOTICE OF CANCELLATION-CERTIFICATE HOLDERS WORKERS <br /> COMPENSATION <br /> The person(s) or organization(s) listed or described in the Schedule below have <br /> requested that they receive written notice of cancellation when this policy is cancelled <br /> by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in <br /> the Schedule a copy of the written notice of cancellation that we sent to you. Such <br /> copies of the notice will be mailed as soon as practicable to the address or addresses <br /> provided by your broker or agent. <br /> This notification of cancellation of the policy is intended as a courtesy only. Our failure to. <br /> provide such notification to the person(s) or organization(s) shown in the Schedule will <br /> not extend any policy cancellation date nor impact or negate any cancellation of the <br /> policy. This endorsement does not entitle the person(s) or organization(s) listed or <br /> described in the Schedule below to any benefit, rights or protection under this policy. <br /> Failure by us to provide this notice of cancellation to the person(s) or <br /> organization(s) listed or described in the Schedule below will not impose liability of any <br /> kind upon us. <br /> Any of these provisions that conflict with a law that controls the notice of cancellation of <br /> the insurance in this endorsement is changed by this statement to comply with the law. <br /> SCHEDULE <br /> Person(s) or Organization(s) including mailing address: <br /> PER THE LISTING OF CERTIFICATE HOLDERS PROVIDED BY THE BROKER <br /> UPON OUR REQUEST. <br /> NOTICE OF CANCELLATION - 30 DAYS <br /> All other terms and conditions of this policy remain unchanged. <br /> WC 99 06 72 09 11 <br /> Attachment Code:D522110 <br /> Certificate ID : 14239807 <br />