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SENTRY INSURANCE A MUTUAL COMPANY SENTRY'S BUSINESSOWNERS <br />STEVENS POINT, WISCONSIN POLICY <br />(A PARTICIPATING MUTUAL COMPANY) <br />A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES <br />POLICY NUMBER 49-39070-01 <br />NAME INSURED: K & A ENTERPRISES INC DBA <br />ADDITIONAL INSURED <br />SCHEDULE <br />The following information is required to complete the accompanying <br />additional insured endorsement which forms a part of the Named Insured's <br />BUSINESSOWNERS POLICY. <br />UM1-1y i-CI:Ii� <br />i11181:M:4'wj4ii <br />THE CITY OF SANTA ANA <br />ITS OFFICERS, EMPLOYEES, <br />AGENTS, VOLUNTEERS & <br />RESPRESENTATIVES <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92701 <br />r, <br />,32,-q;lv Cit,, ALLocney <br />BP 89 05 01 87 (MECH) <br />ALL 49-39070-01 00 021 <br />06-17-2003 <br />(000 0007) <br />EFFECTIVE <br />FROM JUNE 13, 2003 <br />TO SEPTEMBER 23, 2003 <br />