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1 PARAMOUNT <br />inL— <br />Changes e of • or <br />Restrictionda <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />EMPLOYEE BENEFITS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART <br />PRODUCTSiCOMPLETED OPERATIONS LIABILITY COVERAGE PART <br />RAILROAD PROTECTIVE LIABILITY COVERAGE PART <br />STOP GAP LIABILITY COVERAGE PART <br />TECHNOLOGY ERRORS AND OMISSIONS LIABILITY COVERAGE PART <br />SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY - NEW YORK DEPARTMENT OF TRANSPORTATION <br />SCHEDULE <br />Number of days nonce (other than for nonpayment of premium): <br />930 <br />Number of days notice for nonpayment of premium: <br />10 <br />Name of person or organization to wham notice will be sent: <br />City of Santa Ana <br />Pudic blurks Acrency <br />Addrossr �g Civic. Center Plaza M-36 <br />P.O. Puri 1988 M-36 <br />Santa Ana, i. A 92702 <br />If no entry appears above, the number of days notice for nonpayment of premium will be 16 days. <br />It is understood and agreed that in [tie event of cancellation or any material restrictions in coverage during the policy <br />period, the insurer also agrees to mail prior written notice of cancellation or material restriction to the person or <br />organization listed in the above Schedule, Such notice will be sent prior to such cancellation In the manner prescribed In <br />the above Schedule. <br />All outer terms and conditions of the Policy remain unchanged. <br />This endorsement, which forms a pail of and is for attachment to the Policy issued by the designated Insurers, takes effect <br />on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and <br />expires concurrently with said Policy. <br />CNA74702XX(1-15) Policy No. 5oae2®8iae <br />Page 1 of 1 Endorsement No: 28 <br />i`MNISROSRTATION YfidSttPANCE COMPANY Effective Date; 09/0312017 <br />Insured Name: CLINICAL LABORATORIES OF SAN 3ZRNARDIN0, INC <br />Copyis tCHAAM Right Refi&Vad. <br />�4�G 0 /' 7 <br />