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HEALTHCARE PROVIDERS <br />PRO~t:SS10NAt. LiABIL1TY INSURANCE ENDORSEMENT <br />Agreement to Pravlda Notlce of Cancellation <br />In consideration of the premium paid, it is agreed that ifthe policy to which this end~sement is <br />attached is cancelled before fhe expiration date, we will endeavor to mail native to the person or <br />entity named below. However, failure to mail such notice shall impose no obligation ar ligbility of <br />any kind upon the company, its agents or representatives. <br />Person or Entity Name and Address: Cihr of Santa Ana, its Officers, agents <br />and Employees <br />PQ Box 198d <br />Santa Ana CA 92702 <br />Thls endorsement is a part of your policy and takes effect on the effective date of your policy, unless <br />another effective date is shown below All other provisions of the policy remain unchanged. <br />am a -" omp n n rseme s reps <br />.~1s Nat to bo EA'9CtNe ur~h fhb Polk <br />ENDT.NO. poLlcYNO. 1sSUED'ro ENDORSi=MENTEFFEC'11vE <br />2755008 I f Wesley A Bosch ~ 8101109 <br />G123828~g (4712001) <br />DMD 8/07/09 <br />~~.~~•,~ tiz:si 6002-ze-anti <br />