§ 2269.11. California Approved Form Endorsement no. 11.

CALIFORNIA

APPROVED FORM NO. 11

Endorsement Agreement Limiting and Restricting This Insurance

The insurance under this policy is limited as follows:

It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE:

Nothing in this endorsement contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations of this endorsement.

Applicable to and forming part of Policy No. ________________

Issued by the _______________________________________________

To_____________________________________ of __________________

Dated at _____________________this_______day of ______199____

Countersigned _______________________________________________

FAILURE TO SECURE THE PAYMENT OF FULL

COMPENSATION BENEFITS FOR ALL EMPLOYEES AS

REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION

OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION

OF A WORK STOP ORDER, LARGE FINES AND OTHER

SUBSTANTIAL PENALTIES

(Labor Code Section 3710.1, et seq.).

HISTORY

1. New section filed 10-4-60; designated effective 1-1-61 (Register 60, No. 21)

2. Amendment filed 9-18-67; designated effective with respect to all policies and endorsements with an effective date falling on or after April 1, 1968 (Register 67, No. 38).

3. Amendment filed 1-21-81; effective thirtieth day thereafter (Register 81, No. 4).

Note

Note: Authority cited: Sections 11732,11732.1, and 11734, Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2, Insurance Code.