Insurance - Second Chance Orange County - Workers Comp Addendum - 2019-03-01ENDORSEMENT AGREEMENT
9226837-18
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SAN FRANCISCO PAGE 1 OF 1
ALL EFFECTIVE DATES ARE
AT 12:01 AM PACIFIC EFFECTIVE MARCH 1, 2018 AT 12.01 A.M.
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
SECOND CHANCE ORANGE COUNTY
290 PAULARINO AVE
COSTA MESA, CA 92626
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS
AGREED THAT THE MAIL ADDRESS APPEARING IN THIS POLICY
IS CHANGED TO READ -
290 PAULARINO AVE
COSTA MESA, CA 92626
NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND
ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY
OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS IN THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 21, 2019 9908
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AUTHORIZED REPRESENT IVE PRESIDENT AND CEO
SCIF FORM 10217 (REV.4-2018) OLD DP 217
ENDORSEMENT AGREEMENT
9226837-18
NEW
NA
HOME OFFICE
SAN FRANCISCO PAGE 1 OF 1
ALL EFFECTIVE DATES ARE
AT 12:01 AM PACIFIC EFFECTIVE FEBRUARY 16, 2019 AT 12.01 A.M.
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
SECOND CHANCE ORANGE COUNTY
290 PAULARINO AVE
COSTA MESA, CA 92626
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS
AGREED THAT THE FOLLOWING LOCATIONS) APPEARING IN THIS POLICY
IS (ARE) HEREBY ELIMINATED.
307 PLACENTIA AVE STE 203
NEWPORT BEACH CA 92663 3308
NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND
ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY
OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS IN THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 21, 2019 9920
r
AUTHORIZED REPRESENT IVE PRESIDENT AND CEO
SCIF FORM 10217 (REV.4-2018) OLD DP 217