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<br />'-' <br /> <br />.~ <br /> <br />MIDTERM CHANGE DOCUMENT <br /> <br />POUCY NO. PHPK029106 <br />PHILADELPHIA INDEMNITY INSURANCE CO <br /> <br />NAMED INSURED ORANGE COUNTY CONSERVATION CORPS <br />MAILING ADDRESS 700 NORTH VALLEY STREET, SUITE AB <br /> <br />ANAHEIM, CA <br /> <br />92801 <br /> <br />POLICY PERIOD: From 07/20/2002 te 07/20/2003 <br />12:01 AM. Standard Time at yeur maHlng address shown above. <br /> <br />at <br /> <br />CHANGE EFFECTIVE 10/16/2002 <br /> <br />CHANGE # <br /> <br />00003 <br /> <br />DESCRIPTION <br /> <br />IN CONSIDERATION OF NO CHANGE IN PREMIUM, THE POLICY <br />IS AMENDED AS FOLLOWS: <br /> <br />ADDLTIONAL INSURED IS ADDED PER ATTACHED FORM CG2026: <br />SANTA ANA WORK CENTER <br />CITY OF SANTA ANA <br />1000 E. SANTA ANA BOULEVARD, SUITE 200 <br />SANTA ANA, CA 92701 <br /> <br />.. . ...Ud::.U i\S 10 FORM <br /> <br />P781317 <br /> <br />--i#/!//dLj <br />. .m' Sheedy <br />"11'1' City Attorney <br /> <br />Total Annual <br />Additlenal/Return Premium $ <br /> <br />T Dial Prerate <br />Add' nal/Return Premium $_ <br /> <br /> <br />(AutherLzed Representative) <br /> <br />COUNTERSIGNED 10/28/2002 <br />(Date) <br /> <br />BY <br /> <br />inswri <br /> <br />EO/20 'd <br /> <br />1910186508 'ON Xij~ <br /> <br />'08 ~ INIHONij Wij LE:OI 03M 2002-90-^ON <br />