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<br /> <br />. <br /> <br />- .. <br /> <br />S7F. FORM <br /> <br />FORM 199.EZ <br />(Nov. 1957) <br /> <br /><m <br /> <br />ENDORSEMENT <br /> <br />DATED <br /> <br />ATTACHED TO <br />AND FORMING <br />""RTOF <br /> <br />P01.ICY NO. <br /> <br />NAME: OF IN8URANCE COMPANY <br /> <br />7-16-2004 <br /> <br />1135 991 <br /> <br />GuideOne Ins. Co. <br /> <br />AOaNeY AT <br /> <br />¡ISSUED TO <br />Ca. (INSURED'S NAME ill <br />MAILING ADDREJiIIl) <br /> <br />Templo Calvario and Church of No Walls, 2617 W 5th St. Santa Ana, <br /> <br />Carl L Dieda Ins. 680 Langsdorf Dr. # 210 <br />Fullerton Ca. 92831 <br /> <br />COMMENCEMENT OF POLICY <br /> <br />EXPIRATION OF POLICY <br /> <br />EFFEC <br /> <br />ATE OF THIS ENDORSEMENT <br /> <br />6-1-2004 <br /> <br />6-1-2005 <br /> <br />7-1-2004 <br /> <br />""'OUNT OF INSURANCE <br /> <br />PERIL.S <br />FIRE <br /> <br />OL.D RATE <br /> <br />NEW RATE <br /> <br />ADDITIONAL PREMIUM <br /> <br />RETURN PREMIUM <br /> <br />EC< <br /> <br />IT IS HEREBY UNDERSTOOD AND AGREED THAT THE <br /> '.fJi::' .ol:;-~ . ct::, 0(;-:0..':" .0" 0 <br />~? .0" " ."'~ ..:'d"b ..:- ..::: q.' "'"<> ~o <br />~ i".$ &'11 oq, i..$..,$' ¡ :o..C'tfÄ¡'l; <br />'" .~I'fr(, i".$ 0 ~q; <br />~"'.§ 'l.Jt:i.~ ,~ o'" ~ If ",'-'q,,',:.'lJ 'l.J",c..y~' "'*''<' 0'" <br />+t:i.~ ,,<! ,0 <br />:::;.'tI"t:Þ '~'Y't1 "<><) ,,< <1;-'" q,; <it¿ ~ va <:i~~ <;"'.} ð- ~ 0' <br />0 0 0 0 0 0 0 0 0 0 0 <br /> <br />IS CORRECTED OR CHANGED TO READ AS FOLLOWS <br /> <br />As recorded the following is added as Additional Insured to the above policy <br /> <br />The City of Santa Ana, its Officers, Agents <br />and Employees. Santa Ana Work Center <br />1000 E. Santa Ana Blvd. Suite 200 <br />Santa Ana, Ca. 92701 <br />Attn: Bea Gonzalez <br /> <br />As respects to Community Outreach described on attached certificate of Liability <br />Insurance <br /> <br />Insured <br /> <br />~¿" 2/2 <br /> <br />.Consent by.. <br /> <br />.Consent by.. <br /> <br />Mortgagee or Payee <br /> <br />*Not required unless policy is reduced or restricted by this endorsement. <br />