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This Endorsement Changes the Policy. Please Read It Carefully. <br />NOTICE TO CERTIFICATE HOLDER OR DESIGNATED ENTITY <br />INDIVIDUAL <br />This endorsement modifies all coverage parts included in this policy. <br />SCHEDULE <br />PERSON OR ORGANIZATION: <br />of Santa Ana, its officia�bty <br />officers, agents, employees <br />and volunteers <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th <br />Floor <br />Santa Ana, CA 92701 <br />ADDRESS: <br />201, 220 & 305 E. 9TH; 301-307 N. SPURGEON, SANTA ANA, CA 92701 <br />Number of Days Notice of Cancellation: 30 <br />(If left blank, no notice will be sent.) <br />Number of Days Notice of Nonrenewal: <br />(If left blank, no notice will be sent.) <br />This endorsement forms a part of <br />Policy Number: ACVS1325ZO Effective Date: 03-01-2020 <br />Insured: S & A MANAGEMENT, LLC <br />Includes copyrighted material of <br />SIL 02 022 0412 Insurance Services Office, Inc., with <br />its permission. <br />56939719 1 20-21 DL-A -m-WC I Sherry Young 1 8/9/2020 3:02:99 PM (PDT) I Page 6 of 0 <br />�.ycon., RiekMm:agement D[vi6Wn <br />REVIEW®&APPRova:>By: <br />Risk Management Analyst <br />