Cal. Code Regs. tit. 10, § 2260 – Limiting and Restricting Form Specifications.

(a) It shall have bold and/or CAPITALIZED text at the top of the form:
“ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE”
(b) The opening statement shall contain the following language:
“The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy (or “such insurance as is afforded by the policy by reason of the designation of California in Item 3 of the declarations”) DOES NOT INSURE” (or “DOES NOT COVER” or “DOES NOT APPLY TO”).”
(c) It shall have a marginal notation prominently displayed and printed in bold or CAPITAL letters indicating the character of the limitation or restriction stated in the endorsement.
(d) It shall have in bold and/or CAPITALIZED letters the following language:
“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.).”
(e) The words “the insured” may be substituted in any of the approved endorsements for “this employer,” “the insured employer,” “the employer,” or “the named employer.”

Each limiting and restricting form shall conform to the following specifications:

Note: Authority cited: Section 12921(a), Insurance Code. Reference: Sections 11650, 11656.7, 11656.8, 11656.9, 11657, 11658, 11659, 11660, 11661, 11661.5, 11661.6, 11662, 11663, 11664, 11734, 11736 and 11751.5, Insurance Code.

History

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

2. Amendment and renumbering of Section 2259 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).

4. Amendment of section heading, repealer and new section and amendment of Note filed 2-2-2016; operative 4-1-2016 (Register 2016, No. 6).