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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 20 74 <br /> (Ed. 12-16) <br /> NOTICE OF CANCELLATION TO THIRD PARTIES <br /> A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or <br /> organizations shown in the Schedule below by email as soon as practical after notifying the first Named <br /> Insured. <br /> B. This advance email notification of a pending cancellation of coverage is intended as a courtesy only. <br /> Our failure to provide such advance notification will not extend the policy cancellation date nor negate <br /> cancellation of the policy. <br /> SCHEDULE <br /> Name of Other Person(s)/Organization(s): <br /> Per Schedule on file with Company 30 Days <br /> All other terms and conditions of this policy remain unchanged. <br /> Issued by <br /> For attachment to Policy No. WA7-64D-444950-017 Effective Date 6/01/2017 Premium$ <br /> Issued to <br />