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ENDORSEMENT AGREEMENT <br />CERTIFICATE HOLDERS' NOTICE <br />9023428-12 <br />RENEWAL <br />SG <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE SEPTEMBER 1, 2012 AT 12.01 A.M. PAGE 1 OF 1 <br />ALL EFFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />2-1-1 ORANGE COUNTY <br />PO BOX 14277 <br />IRVINE, CA 92623 <br />ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, <br />IT IS AGREED THAT THIS POLICY SHALL NOT BE CANCELLED UNTIL, <br />30 DAYS <br />AFTER WRITTEN NOTICE OF SUCH CANCELLATION HAS BEEN PLACED <br />IN THE MAIL BY STATE FUND TO CURRENT HOLDERS OF <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE. <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br />POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS OF THIS ENDORSEMENT. -- <br />� � 'W.4A1a,wggnail Dh4Gm <br />F,�,' fsenEwmxArrnwmer. <br />COUNTERSIGNED AND ISSUED AT SAy/N FRFRANCISCO: SEPTEMBER 24, 2COO{//J�y./�2y,�� <br />/%A�y�V '" o/tlYK 411 ��i ,_ RkkMvk 9e�,Y,MCIHi'alNtic <br />l <br />AUTHORIZED REPRESENTA IVE PRESIDENT AND CEO 2065 <br />SCIF FORM 10217 (REV.1.2012) OLD OF 217 <br />