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M 19279 <br />RENEWAL DECLARATIONS (CONTINUED) <br />Office Policy for MENTE INC <br />Polity Number 92-EK-V825-4 <br />CMP-4787 Waiver of Trans Rgi of Recov <br />FD-6007 Inland Marine Attach Dec <br />New Form Attached <br />SCHEDULE OF ADDITIONAL INTERESTS <br />Interest Type: Addl Insured -Section ll <br />Endorsement #: CMP47861 <br />Loan Number: N/A <br />CAPISTRANO UNIFIED SCHOOL <br />DISTRICT <br />33122 VALLE RD <br />SAN JUAN CAPO CA 926754859 <br />Interest Type: Addl Insured -Section ll <br />Endorsement #: CMP47861 <br />Loan Number: N/A <br />RANCHO SANTIAGO COMMUNITY <br />COLLEGE DISTRICT <br />2323 N BROADWAY <br />SANTAANACA 927061606 <br />Interest Type: Addl Insured -Section II <br />Endorsement#: CMP47861 <br />Loan Number: N/A <br />THE CITY OF SANTAANA ITS <br />OFFICERS, EMPLOYEES, AGENTS <br />VOLUNTEERS ARE NAMED AS <br />ADDITIONAL INSURED WITH REGARD <br />20 CIVIC CENTER PLZ <br />SANTAANACA 927014058 <br />This policy is issued by the State Farm General Insurance Company. <br />Participating Policy <br />You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in <br />accordance with the Company's Articles of Incorporation, as amended. <br />In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and <br />Secretary at Bloomington, <br />�Illinois. <br />('/" 'QDy <br />Sec)reta7y <br />President <br />Prepared <br />MAR 032020 VCopynght State FarmMuaal Putomobile Insurance Conpany.20H <br />CMP-4000 Includes copyndled mammal N Inwrance Services Office, Inc., with o permiszon. <br />019281 Continued on Next Page Page 6 of 8 <br />Risk Managtmant Division <br />i� v c REVIEWED&APPROVID BY: <br />v 1 <br />v ! Rnk Management Analyst <br />