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* S1 * 12/21/2021 * GLP-4293348-06-02 GREAT AMERICAN ASSURANCE CO <br />378559 <br />IL 70 02 (Ed. 10 07) <br />Policy No. GLP 429-33-48 - 06 <br />Effective Date of Change 12/13/2021 <br />POLICY CHANGES <br />NAMED INSURED CASA DE LA FAMILIA <br />AND ADDRESS: 1650 E 4TH STREET 101 <br />SANTA ANA CA 92701 <br />POLICY ALTERNATE MAILING ADDRESS: <br />THIS ENDORSEMENT <br />CHANGES THE POLICY. <br />PLEASE READ IT <br />CAREFULLY. <br />AGENT'S NAME •ADDRESS:THE VAN WAGNER -y <br />`! BOX 9017 <br />WOODBURY, NY 11797 <br />Insurance is afforded by the Company named below, a Capital Stock Corporation: <br />GREAT AMERICAN ASSURANCE COMPANY <br />POLICY PERIOD: From 05/06/21 To 05/06/22 <br />12:01 A.M. Standard Time at the address of the Named Insured <br />i <br />i�iil�1•C1�:7 cT'/;Ts7:7� �7a��1��1/�17:1:�1r �hl�i�ar�r dai&Mafl0i[il'M&WA]11:1kj1 <br />Vigo <br />iNA <br />1 • • i <br />FORMS A• ENDORSEMENTS hereby••-• 1 i <br />Agent Signature <br />IL 70 02 (Ed. 10107) PRO (Page 1 of 1) <br />Date <br />o Nye RiskMwaganadDMsian <br />z <br />REVIEWED & APPROVED BY.- <br />1 Risk Management Analyst <br />