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POLICY NUMBER: 20 UUN IQ9229 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />NOTICE OF CANCELLATION <br />TO DESIGNATED CERTIFICATE HOLDER <br />SCHEDULE <br />Number of Days Notice: Name of Certificate Holder: <br />CITY OF SANTA ANA, ITS OFFICERS, <br />Part A: 30 EMPLOYEES,AGENTS,VOLUNTEERS,REPS <br />Part B: 10 Mailing Address: <br />RISK MANAGEMENT DIVISION, FL 4 <br />Part C: 10 20 CIVIC CENTER PLZ <br />SANTA ANA, CA 92702 <br />This policy is subject to the following additional <br />Conditions when a number of days are shown in the <br />Schedule for any of the above Parts. <br />A. If this policy is cancelled by the Company, other <br />than for nonpayment of premium, notice of such <br />cancellation will be provided to the certificate <br />holder in the Schedule, at least the number of <br />days in advance of the cancellation effective date, <br />as shown in Part A. <br />B. If this policy is cancelled by the Company for <br />nonpayment of premium, notice of such <br />cancellation will be provided to the certificate <br />holder in the Schedule within the number of days <br />notice of the cancellation effective date, as shown <br />in Part B. <br />C. If this policy is cancelled by the insured, notice of <br />such cancellation will be provided to the certificate <br />holder in the Schedule, within the number of days <br />notice of the cancellation effective date, as shown <br />in Part C. <br />If notice is mailed, proof of mailing notice to the <br />certificate holder's mailing address as shown in <br />the Schedule will be sufficient proof of notice. If <br />the number of days notice in the schedule for any <br />Part is left blank or is shown as zero, no notice will <br />be provided to the Scheduled certificate holder <br />under that Part. <br />Any notification rights provided by this <br />endorsement apply only to active certificate <br />holder(s) who were issued a certificate of <br />insurance applicable to this policy's term <br />Failure to provide such notice to the certificate <br />holder(s) will not amend or extend the date the <br />cancellation becomes effective, nor will it negate <br />cancellation of the policy. Failure to send notice <br />shall impose no liability of any kind upon the <br />Company or its agents or representatives. <br />Form IH 03 15 06 11 <br />© 2011, The Hartford <br />�oRaN <br />} z <br />RiskMmWmedDMsfan <br />REVIEWED & APPROVED BY.- <br />f R. V;d <br />Risk Management Analyst <br />