**Document Title:**

This document appears to be an insurance endorsement form from Zurich Insurance Company and American Guarantee and Liability Insurance Company.

**Details:**

- **Policy No.:** 0840230
- **Eff Date of Pol:** 1-1-76
- **Eff Date of End:** 1-1-76
- **Agency No.:** (Not filled)
- **Add'l Premium:** $ (Not filled)
- **Return Premium:** $ (Not filled)

**Named Insured:**

This endorsement is issued by the company named below, which is the insurer under the policy designated above, issued to the Named Insured and forms a part of said policy as of the effective date hereof, at the hour stated in the policy Declarations.

**Agreement:**

It is agreed that written notice of cancellation, material change or a deduction in coverage of said policy shall be delivered to the City Attorney, Room 2115, Los Angeles City Hall, Los Angeles, Calif., thirty (30) days in advance of the effective date thereof.

**Signatures:**

The document includes signatures from Zurich Insurance Company and American Guarantee and Liability Insurance Company.