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<br />Certificate Endorsement# 1 <br />SPECIAL EVENT Insurance Program <br /> <br />This Endorsement is Attached to and made part of Certificate# SSA03-0013. <br />Coverage Part: Commercial General Liability <br />Effective Date of this endorsement is: 5/15/2003 at 12:01am <br />Insurance Company: Essex Insurance CUlllfJdllY <br /> <br />Insured: Juan, Jorge <br />3866 Canterbury Rd <br />Riverside, CA 92504 <br /> <br />This certificate is amended to include the attached company coverage endorsement. All <br />other terms and conditions remain the same. <br /> <br />The following Endorsement adds: Community Redevelopement Agency, Community <br />Development Agency, City of Santa Ana, & The Housing Authority on to the policy. <br /> <br />Premium __H- . . $QI <br />Taxes ~g:'QQi <br />Certificate Fee $01 <br />Total-- $o.od <br />--.-.-.. ....._] <br /> <br />APPROVED AS TO FORM <br /> <br />L.i!i:: 0 d1 <br /> <br />Deputy City Attorney <br /> <br />1920 East 17th St Suite 130 Santa Ana, CA 92705 (800) 420-0555 (714) 550-5040 fax (714) 550-5044 License# OC04849 <br />