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ENDORSEMENT <br />_ Golden Eagle <br />Insurance. <br />Ymbadlbu„YVCd G,ap <br />Policy Number: CBP9572743 Prlor Policy: 9672743 <br />Billing Type: DIRECT BILL <br />Coverage Is Provided In GOLDEN EAGLE INSURANCE CO RPORATION <br />Named Insurod and Malling Address: Agent: <br />MASTER LANDSCAPE & MAINTENANCE ELMCO INSURANCE <br />INC 1905 N MAIN ST <br />10171 NORTHAMPTON AVENUE SANTA ANA CA 92706.2728 <br />WESTMINSTER CA 92683 <br /> Agent Code: 4294058 Agent Phone: (714)-973-1438 <br />POLICY CHANGE ENDORSEMENT <br />LICY PERIOD: From: 04102!2009 To: 04102!201 D at 12:01 AM Standard 1 <br />DESCRIPTION OF CHANGE <br />THE FOLLOWING PRIMARY NON CONTRIBUTORY <br />APPLIES PER THE ATTACHED 17.59 AND 22.123 A <br />CITY OF SANTA ANA <br />P.O, BOX 1988 <br />SANTA ANA, CA 9274 <br />JOB: LAWN MAINTEN <br />ANA, <br />DURATION: ANNUAL <br />4 SANTA <br />mailing address shown above. <br />DATE: 0 711 012 0 0 8 <br />Original Annual Premium ~ 31,141.0 0 <br />New Annualized Premium ~ 31 , 2 4 6.0 0 TOTAL ADDITIONAL PREMIUM ~ 7 7.0 0 <br />Countersigned: By <br />Aulhotized Representative Dete <br />Date Issued: 07/1512009 <br />17.60 (10194) <br />INSURED COPY <br />04ID2/200g 9572743 NEUSX01P16D7 P(3DM050D J10981 t3CAFPPN 00000111 Pege 5 <br />