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1: <br />Interinsurance Exchange of the Automobile Club <br />®; P.O. BOX 25001, SANTA ANA, CALIFORNIA 92799 -5001 <br />Notice of Cancellation Endorsement <br />Forming a part of Policy No. CAA 065514880 issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB <br />to ROYER, DAVID C AND MARY E <br />Effective 09 -19 -2013 12:01 A.M. Pacific Standard Time <br />PUBLIC WORKS AGENCY M -43 <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92702 <br />It is agreed that in the event of: <br />09 -18 -13 <br />Loan No. <br />DESIGNATED AUTOMOBILE: <br />2005 CHRY 1C3AN69L05X053841 <br />• material change to this policy affecting the designated automobile; or <br />• suspension or nonrenewal of this policy, or <br />• cancellation of this policy at the request of other than the Interinsurance Exchange, or <br />• cancellation of this policy at the request of the Interinsurance Exchange for nonpayment of premium; <br />10 days' written notice thereof will be given by regular mail to the additional insured named above. <br />In the event of cancellation of this policy by the Interinsurance Exchange for other than nonpayment of premium, 20 days' written notice <br />thereof will be given by regular mail to the additional insured named above. <br />All provisions of your policy not affected by this endorsement remain unchanged. <br />ACSC Management Services, Inc. <br />ATTORNEY -IN -FACT <br />CERTIFICATE OF INSURANCE <br />This is to certify to the additional insured named above that the Interinsurance Exchange of the Automobile Club has issued the above <br />listed Member's Automobile Policy to the policyholder named above. Subject to its terms and provisions, this policy, including any <br />applicable endorsement, provides the following coverages and limits of liability for the designated automobile: <br />BODILY INJURY <br />LIABILITY <br />PROPERTY DAMAGE <br />LIABILITY <br />THOUSAND <br />THOUSAND <br />THOUSAND <br />DOLLARS <br />DOLLARS <br />DOLLARS <br />EACH <br />EACH <br />EACH <br />PERSON <br />OCCURRENCE <br />OCCURRENCE <br />500 <br />500 <br />100 <br />This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the coverages afforded by and the terms and <br />conditions applicable to the policy to which it pertains. <br />ACSC Management Services, Inc. <br />ATTORNEY -IN -FACT <br />CAA0307A 2059 <br />a'm mroq E 1 -96 <br />