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Ir'r 0- 20472 -A <br />CNN (Ed. 10193) <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />NOTICE OF CANCELLATION OR MATERIAL CHANGE ENDORSEMENT <br />In the event of cancellation or other material change of the policy, we will mail advance notice to the person or <br />organization named in the Schedule. The number of days advance nodes is shown in the Schedule. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />1. Number of days advance notice: 30 <br />2, Notice will be mailed to: <br />CITY OF LAMIRADA <br />13700 LAMIRADA BLVD <br />LAMIRADA, CA 90638 <br />'C'ITY OF SANTA AMA - <br />V-'20 CIVIC ENTER PLAZA {M -30} <br />P.O. BOX 1988 <br />SANTA ANA, CA 9270221988 <br />G- 24472 -A Page 1 of 1 <br />(Ed. 10193) {jst;K <br />LISa GitY`�io } <br />