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iy <br />Y <br />R <br />POLICY NUMBER INSURED NAME AND ADDRESS <br />B 6025612892 Gruen Associates <br />6330 SAN VICENTE BLVD STE 200 <br />LOS ANGELES, CA 90048 <br />POLICY CHANGES <br />ENDORSEMENT EFFECTIVE 06/16/2021 <br />This Change Endorsement changes the Policy. Please read it carefully. <br />This Change Endorsement is a Part of your Policy and takes effect on the <br />effective date of your Policy, unless another effective date is shown. <br />The following Form(s) has (have) been amended: <br />Form #: SB-147052-C Title: CHANGES - NOTICE OF <br />CANCELLATION OR MATERIAL COVERAGE CHANGE <br />The following Name has been added to this form: <br />CITY OF SANTA ANA RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA 4TH FLOOR <br />SANTA ANA CA 92702 <br />Chairmen et the Board <br />G-56015-B (ED. 11/91) <br />R�L MPIIWmIh: ti <br />RUM NAruge�nnr ❑vial Aitle '� <br />