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POLICY NUMBER: 6078951418 <br />G-20472-A <br />CNA (Ed. 10/93) <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />NOTICE OF CANCELLATION OR MATERIAL CHANGE ENDORSEMENT <br />In the event of cancellation or other material change of the policy, we will mail advance notice to the person or <br />organization named in the Schedule. The number of days advance notice is shown in the Schedule. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />1. Number of days advance notice: 30 <br />2. Notice will be mailed to: <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />G-20472-A <br />(Ed.10/93) <br />57014a01 I N=T-1 120-21 Master Certificate I Prabhjot Kacr 19/23/2020 2:39.23 PN IP'JT) I Page 11 of 11 <br />RiskMmugenmiEl vision <br />rrREVIEWED 6 APPRavm By., <br />�. <br />MRisk R9anagemen[ Malys[ <br />