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CiNA <br />PARAMOUNT R y <br />Changes - Notice of Cancellation or Material <br />Restriction Endorsement <br />This endorsement modifies insurance provided under the followlitg: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />EMPLOYEE BENEFITS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART <br />PRODUCTSiCOMPLETED OPERATIONS LIABILITY COVERAGE PART <br />RAILROAD PROTECTIVE LIABILITY COVERAGE PART <br />STOP GAP LIABILITY COVERAGE PART <br />TECHNOLOGY ERRORS AND OMISSIONS LIABILITY COVERAGE PART <br />SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY — NEW YORK DEPARTMENT OF TRANSPORTATION <br />SCHEDULE <br />Number of daps notice (other than for rionpaymerit of premium): <br />030 <br />Number of days notice for nonpayment of premium: <br />Io <br />Name of person or organization to whom notice will be sent: <br />City of Santa Ana <br />Public Works Agency <br />Address; 2(i C:i.vi.c Center: Plaza <br />M -3F <br />P.O. Box 1988 i1-36 <br />Sarita Ana, CA 92702, <br />If no entry appears above, the number of days notice for nonpayment of premium will be tQ days. <br />It is understood and agreed that in the event of cancellation or any material restrictions in coverage during the policy <br />period, the Insurer also agrees to mail prior written notice of cancellation or material restriction to the person or <br />organization listed in the above Schedule. Such notice will be sent prior to such cancellation in the manner prescribed In <br />the above Schedule. <br />All other terms and conditions of the Policy remain unchanged. <br />This endorsement, which forms a past of and Is for attachment to the Policy issued by the designated Insurers, takes effect <br />on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and <br />expires concurrently with said Policy. <br />CMA74702XX (1-15) <br />Page I of t <br />T" R.�1NSPORTATION INSURANCE COMPANY <br />Insured Name: CLINICAL LABORATORIES OF SAN BERNARDINO, INC <br />Ccrryright (;NAPA Riots Ros ad. <br />Policy No: 50611208188 <br />Endorsement No( as <br />Effective Date: 94/021/2017 <br />Wj1P , l'ei's 7 rf 7 <br />