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<br /># <br /> <br />POLICY CHANGE DOCUMENT <br /> <br />POLICY NO.: PHPK162357 <br /> <br />Philadelphia Indemnity Insurance Company 18894 ASHBROOK-CLEVIDENCE, INC. <br /> <br />NAMED INSURED Orange County Bar FoundatIon <br /> <br />MAILING ADDRESS PO Box 986 <br />Santa Ana, CA 92702~0986 <br /> <br />POLlCY PERIOD: FROM 03/15/2006 TO 03/15/2007 at <br />12:01 A.M. Standard Time at your mailing address shown above. <br /> <br />CHANGE EFFECTIVE 03/15/2006 <br /> <br />CHANGE # 4 <br /> <br />DESCRIPTION <br /> <br />In consideration of the premium reflectecI, the policy is amended as indicatecI below: <br /> <br />AMENDING THE ADDmONAL INSURED TO READ AS FOLLOWS: <br /> <br />CITY OF SANTA ANA <br />P. O. BOX 1988 <br />SANTA ANA, CA 92702 <br /> <br />~-_3!tt:___.~ _~ <br /> <br /> <br />;.<~~,/ <br /> <br />Path ID 1964761 <br /> <br />Total Annual <br />Additional/Relurn Premium $ <br /> <br />0.00 <br />NO CHANGE <br /> <br />Total Prorate <br />Additional/Retum Premium $ <br /> <br />0.00 <br />NO CHANGE <br /> <br />COUNTERSIGNED <br /> <br />BY <br /> <br />(Date) <br /> <br />(Authorized Representative) <br /> <br />Page 1 of 1 <br />