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STARR. SPECIALTY INSURANCE, COMPANY <br />A MEMBER OF STARR COMPANIES <br />Dallas, TX 1-866-519-2522 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 18 <br />(Ed. 4-15) <br />AMENDMENT — 30 DAY NOTICE OF CANCELLATION FOR THIRD PARTIES <br />We agree to give thirty (30) days' notice of cancellation to the following certificate holder(s) in the event that we <br />cancel the policy for any reason other than non-payment of premium: <br />GHED LE <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4111 Floor <br />Santa Ana, CA 92701 <br />Attn: Francine Villareal <br />Email Address: RMD@Sang Ana ara <br />We will endeavor to provide advice of cancellation (the "Advice') to the certificate holders listed in the schedule <br />by e-mail. Certificate holders include only those entities for which thirty (30) days' notice of cancellation is <br />required by an "insured contract" but only with respect to an entity for which you are directly or indirectly <br />performing your work. <br />This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to <br />provide such Advice will neither extend the policy cancellation nor negate cancellation of the policy; nor will such <br />failure result in obligation or liability of any kind upon us, our agents or representatives. <br />This endorsement does not affect, in any way, coverage provided under this policy, the cancellation of this policy <br />or the effective date of cancellation. <br />This endorsement changes the policy to which It Is attached and is effective on the date Issued unless otherwise stated. <br />(The Information below Is required only when this endorsement is Issued subsequent to preparation of the policy.) <br />Endorsement Effective 07/2112020 <br />Insured: West Coast Arbodsts, Inc. <br />Policy No.: 100 0004228 <br />Premium: Included <br />Insurance Company: stars Specialty msurREVIEWED& APPROVEL, <br />ii�Pifg'RPi IKNACEhter„9q"q%4Red by: <br />WC 99 06 18 <br />(Ed. 4-15) Copyrigl+96l UA(M6 lttyWLkAkiC fMmpany. All rights reserved. <br />Endorsement No.: <br />Page 1 of 1 <br />