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6809H717919 <br />BA8F335897 <br />POLICY NUMBER: UB4K463295 <br />CUP71<299343 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED ENTITY- NOTICE OF <br />CANCELLATION PROVIDED BY US <br />This endorsement modifies insurance provided under the following: <br />ALL COVERAGE PARTS INCLUDED IN THIS POLICY <br />SCHEDULE <br />CANCELLATION: Number of Days Notice of Cancellation: 30 <br />PERSON OR City of Santa Ana <br />ORGANIZATION: Attn: Risk Management Division <br />ADDRESS: 20 Civic Center Plaza <br />Santa Ana CA 92701 <br />PROVISIONS: <br />If we cancel this policy for any statutorily permitted <br />reason other than nonpayment of premium, and a <br />number of days is shown for cancellation in the <br />schedule above, we will mail notice of cancellation to <br />the person or organization shown in the schedule <br />above. We will mail such notice to the address shown <br />in the schedule above at least the number of days <br />shown for cancellation in the schedule above before <br />the effective date of cancellation. <br />IL T4 05 03 11 © 2011 The Travelers Indemnity Company. All rights reserved. <br />63689145 121-22 GL-AL-UL-WC, 20-21 PL I Sherry Young 18/31/2021 4:23:14 PM (PDT) I Page 8 of 8 <br />Page 1 of 1 <br />Q rznry <br />' <br />RiskMwagemedDiMsiun <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />