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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 />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA <br />P.O. BOX 1988 <br />SANTA ANA, CA 92702-1988 <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. CPLS1033HO Effective Date: 3/1I2021 <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 />Ride Mmlagemait Divielars <br />�rI:�.s cRene & APPROVED BY. <br />L� r�1GhG�-K �. YaGWFK <br />Ruk Management Analyst <br />60484813 121-22 WC-GL-A -I I Stacy Eickha Ef 13/3/2021 4:14:19 PM IPST) I Page 5 of 12 <br />