Laserfiche WebLink
cr.011 't,YSC FAX hO. :909- 924 -9889 Oct. 29 2007 10:16AM P2 <br />POLICY CHANGE DOCUMENT <br />POLICY NO.: PHPK254348 <br />Philadelphia Indemnity Insurance Company 26548 The Allen 1. Flood Companies, Inc. <br />NAMED INSURED The California Youth Spirit & ' <br />Twirling Corps. <br />MAILING ADDRESS 22755 Mesa Springs Way <br />Moreno Valley, CA 92557 -2628 <br />POLICY PERIOD: FROM 0910112007 TO 09/01/2008 at <br />12:01 AM. Standard Time at your mailing address shown above. <br />CHANGE EFFECTIVE 09 /01/2007 CHANGE # 2 <br />DESCRIPTION <br />In consideration of the premium reflected, the policy is amended as Indicated below <br />With respect to claims arising out of the operations and uses performed by <br />or on behalf of the named additional insured (City of Santa Ana, and their <br />respective officers, employees, agents, volunteers and representatives), <br />such insurance as Is afforded by this policy Is Primary / Non - contributory <br />with any other insurance carried by or for the benefit of the additional <br />insured. <br />Path ID 2536129 <br />Total Annual <br />AddifonallRetum Premium S 300.00 <br />ADDITIONAL <br />COUNTERSIGNED BY <br />(Date) <br />Total Prorate <br />Additional/Ratum Premium S 300.00 <br />ADDITIONAL <br />(Authorized Representative) <br />insured Copy Page 1 or 1 <br />