Laserfiche WebLink
POLICY NUMBER:N9BP226299 <br />Date Processed: 06/11/2021 <br />BUSINESSOWNERS <br />BP 12 01 07 02 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />BUSINESSOWNERS POLICY CHANGES <br />Ruby Gutierrez <br />200 W Columbine Ave Apt B1 <br />Santa Ana, CA 92707 <br />THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW. <br />POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY <br />N9BP226299 06/12/2021 Berkshire Hathaway Direct Insurance <br />Company <br />NAMED INSURED AUTHORIZED REPRESENTATIVE <br />Ruby Gutierrez <br />CHANGES <br />Additional Insured - Designated Person or Organization <br />Added Name of Person or Organization: City of Santa Ana ISAOA ATIMA Risk Man- <br />agement Division <br />Address: 20 Civic Center Plaza <br />City: Santa Ana <br />State: CA <br />Zip: 92702 <br />Policy Forms <br />Added Additional Insured - Designated Person or Organization (BP 04 48 01 06) <br />Added Primary and Noncontributory - Other Insurance Condition (BP 14 88 07 13) <br />BP 12 01 07 02 © ISO Properties, Inc., 2001 <br />�oRaN <br />RiskMmaganadDMsfan <br />REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />