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CNA Healthcare Primary Policy Endorsement In the event this policy is cancelled prior to its expiration date or nonrenewed, the Insurer agrees pursuant to the request of the First Named Insured to also give notice of cancellation or nonrenewal to the certificate holders at the email addresses set forth in the SCHEDULE below. If the Insurer cancels for nonpayment of premium, the Insurer will endeavor to give 10 days notice. If the Insurer cancels for any reason other than nonpayment of premium, the Insurer will endeavor to give 30 days notice. In the event this policy is nonrenewed, the Insurer will endeavor to give 120 days notice. As a condition precedent to giving such notice to the certificate holders, the Insured or the broker of record must complete and return to the Insurer the SCHEDULE OF CERTIFICATE HOLDERS below to whom the First Named Insured requests that the Insurer provide notification of such cancellation or nonrenewal. Upon receipt of the completed SCHEDULE, the Insurer shall endeavor to provide notification to those certificate holders at the email address set forth in such SCHEDULE. Such SCHEDULE must be completed and returned to the Insurer within 5 business days of notice to the Insured of cancellation. If the SCHEDULE is not returned to the Insurer within 5 business days, such notice will not be provided. The Insurer will assume that the schedule provided by the Insured or the broker is a complete and accurate list of certificate holders. Only those persons or entities listed on the SCHEDULE will receive notification. The Insurer will keep no other record of any certificate holders on file. Any notification by the Insurer to any party that is not the First Named Insured shown on the Declarations is intended as a courtesy only. Any failure to provide such notification will not extend the policy cancellation date, or negate cancellation or nonrenewal of the policy, or be cause for legal action against the Insurer. South Bay Workforce Investment Mailing Address: 11539 Hawthorne Blvd. Suite 500, Hawthorne, IBoard, Inc CA. 90250 City of Santa Ana, officers, agents, Mailing Address: 20 Civic Center Plaza, 4th Floor, Santa Ana, CA employees, and volunteers 92702 All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: CNA82354XX (01-2016) Endorsement Effective Date: 04/22/2021 Endorsement Expiration Date: Endorsement No: 20; Page: 1 of 1 Underwriting Company: Columbia Casualty Company, 161 N Franklin St, Chicago, IL 60606 ® Copyright CNA All Rights Reserved. xy Risk Mens wnt misim �f REVIEWED &APPROVE) By, 3 1', Risk Management Analyst