CTR051357_24-25_WC_NOC.pdf
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- Attached to
- Master Agreement AZ|CTR051357
- Contract number
- CTR051357
- Issued by
- Arizona
About this file
This document is a Workers' Compensation and Employers' Liability Policy endorsement issued by ACE American Insurance Company for MedImpact Holdings Inc., located in San Diego, California. The policy is effective from 04-30-2024 to 04-30-2025, with a policy number RWC (25)7184-00-64. The endorsement specifically outlines a "Notice to Others Endorsement - Schedule" regarding policy cancellation notification procedures, and notably does not apply in the states of Arizona, Florida, Idaho, Maine, North Carolina, New Jersey, New Mexico, Texas, and Wisconsin.
The endorsement details the process by which the insurance company will attempt to notify additional parties listed in a schedule if the policy is canceled prior to its expiration date for reasons other than non-payment of premium. The document emphasizes that these notifications are courtesy communications and do not create any legal obligations. The insurance company will only be responsible for sending notice to the insured's representative, who must then forward cancellation information to scheduled parties at least 30 days before the cancellation date. The endorsement explicitly states that it does not apply if the insured cancels the policy, and all other policy terms remain unchanged.
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Text version
WC 99 03 69 (01/11) Page 1
Workers' Compensation and Employers' Liability Policy Named Insured
MEDIMPACT HOLDINGS INC.
10181 SCRIPPS GATEWAY COURT
SAN DIEGO CA 92131
Endorsement Number
Policy Number
Symbol: RWC Number: (25)7184-00-64 Policy Period
04-30-2024 TO 04-30-2025
Effective Date of Endorsement 04-30-2024
Issued By (Name of Insurance Company)
ACE AMERICAN INSURANCE COMPANY
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
NOTICE TO OTHERS ENDORSEMENT – SCHEDULE
NOTICE BY INSURED’S REPRESENTATIVE
A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the “Schedule”) by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy.
B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy.
C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use.
D. We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule.
E. This endorsement does not apply in the event that you cancel the Policy.
All other terms and conditions of this Policy remain unchanged.
This endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM, TX and WI.
Authorized Representative
File details come from the government source that posted it. Updated .