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WORKERS' COMPENSATION AND EMPLOYERS LIABILITY POLICY <br />Na4fed.ln5ured; <br />Comcast Corporation <br />Endorsement Numbor" <br />Po116y Numudr <br />Symbol WLR NnmbocC66040719. <br />Pofidy Pariod, - - <br />Effective Dale of Endom.ment(- <br />1211 19 TO,12?1120 <br />lasuod BY (Nnirq of nsursnce company): <br />Indomnity Insdrance Co of North America <br />tr)aerit¢@ goliay nnmbdc The remafnd er: or the utrormggon is to $e een7plpted only wlteli this endoasem"ontis�ssuodsubserytleni to Ihu, yreparation tiflhu pd€(ay: <br />NOTICE TO OTHERS ENDORSEMENT-;SPEGIF C PARTIES; <br />A. If we cancel this Policy prior to: its expiration date by notice to you or the first Named.. insured for any <br />reason other than nonpayment of premium, we will endeavor, as set out below,10 send written notice of <br />cancellation, via such electronic or other"form of notification as we determine, to the persons or <br />organizations listed in the schedule set out below (tlo "Schedule"). You or your representative must <br />provido us with both the physical ;and e-mail_ address of such persons or organizations, and we will utilize <br />such e-mail address or physical address that you or your representative provided to us on such <br />Schedule, <br />13. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding;_ <br />to each person or organization Indicated in the Schedule at least 30 days prior to the cancellation date= <br />applicable to the Policy. <br />C. The notice referenced in this endorsement is Intended only to he a courtesy notification to the persons) <br />or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have <br />no legal obligation of any kind to any such person(s) or organizatlon(s,). Our failure to provide advance <br />notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no <br />obligation or liability of any kind) upon us, our agents or representatives, will not extend any Policy, <br />cancellation date and will not negate any cancellation of the, Policy, <br />1). We are not responsible for verifying any information provided to LIS in any Schedule, nor are we <br />responsiole;fnr any Incnnact information that you or your representative provide to us_ If you or your <br />representative does riot provide us with the Information necessary to complete the Schedule, we have <br />he responsibility for taking any action under this andorsoment, In addition, If neither you nor your <br />representative provides us with e-mall and physical ;address informarboh with respect to a pa'cular <br />person or organization, then we shall have no responsibility for taking action with regard to such person <br />or entity Linder this endorsement. <br />E. We may arrange with your representative to send such notice in the event ofanysuch cancellation: <br />F. You will cooperate with us in providing, or In causing' your representative to provide; the e-mail address <br />and physical address of, the persons or organizations listed in the Schedule. <br />G. This endorsement does not apply in the event that you cancel the Policy. <br />SCHEDULE <br />Name of Certificate Holder <br />E-Mail Address <br />Physical Address <br />City o€Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th floor <br />Santa Ana, CA 92701 <br />qc S; 03 t i (vii i i ) <br />Page 1 of,2 <br />Ja sv, <br />, yK°� <br />'� I <br />Wok Managzmam6Divieton <br />-R2gEwEc&APPR0/maY: <br />�o' <br />Risk Managenien(Analyst C <br />