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<br />I' , <br />I' 2Y . <br /> <br />2m 1 Tfyl <br /> <br />31' OVin & 3 r OH ,r,c <br /> <br />1',0,2411 ~,L <br /> <br />Policy Change 0 0 01 <br />Number <br /> <br />GU 269 <br />(11-ll5) <br /> <br />THE ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />IL 12 01 11 85 <br /> <br />POLICY CHANGES <br /> <br />05/04/05 <br /> <br />I COMPANY <br />GREAT AMERICAN ASSURANCE <br />COMPANY <br /> <br />POLlCY NO. <br /> <br />GLP00005689.96400 <br /> <br />POUCY CHANGES <br />EFFECTive <br /> <br />NAMED INSURED <br /> <br />AUTHORIZED REPRESENTAllVE <br /> <br />LADIES PROFESSIONAL GOLF ASSOCIATION <br /> <br />K&K INSURANCE AGENCY,INC. <br /> <br />COVERAGE PARTS AFFECTED <br /> <br />PAGE 01 OF 01. <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />CHANGES <br /> <br />THE POLICY IS AMENDED AS FOLLOWS: <br />ADD ADDITIONAL INSURED PER FORM CG 201.1." ADDITIONAL INSURED _ MANAGERS <br />OR LESSORS OF PREMISES. <br />CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND <br />REPRESENTATIVES. <br />FORM GAC35BOCG "POLICY CONDITIONS" IS BEING ADDED TO THE POLICY WITH <br />RESPECTS TO THE ABOVE MENTIONED ADDITIONAL INSURED. <br /> <br />THE INSURED <br />IS IMPAIRED <br />RESPONSIBLE <br /> <br />HEREBY ACKNOWLEDGES THAT THEIR CANCELLATION OF THE POLICY <br />DUE TO THE ATTACHED GAC 35BOCG (07/03) AND WILL BE <br />FOR ANY PREMIUM PAYMENT DUE DURING THE NOTIFICATION PERIOD.. <br /> <br />INSURED NAME <br /> <br />-DATE <br /> <br />APPROVED AS TO FORM <br /> <br />;;/!!D 3/C:; <br /> <br />Y Laura Stitt Sheedy <br />Assistant City Attornev <br /> <br />Copyright Insurance Sorvicos Office, Inc, 1983 <br />Copyright, ISO Commercial Risk Services Inc 1983 <br /> <br /> <br />JA 05/04/05 <br /> <br />