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Assured: <br />CITY OF SANTA ANA <br />Coverage: <br />Recapitulation of Verified Detail <br />Values at Risk: <br />LOSS AS DETERMINED: <br />ATI Demo Gym Floor <br />McWill Sports Surfaces <br />FINAL STATEMENT OF VALUE AND LOSS <br />Date of Loss: <br />9 7 2018 <br />Loss Location: <br />JEROME CENTER <br />726 S. CENTER ST. <br />SANTA ANA, CA 92704 <br />Manuscript form extending All Risk cover <br />for Real and Personal property. There is <br />$10,000 deductible applicable. <br />Value Loss <br />$ 17,327.00 <br />$ 88,543.00 <br />Value and Loss: $ 105,870.00 <br />Less: Deductible: $ (10,000.00) <br />Net Claim: $ 95,870.00 <br />MCLarens File No.: 002.047232.00.1 <br />rI- <br />