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<br />RUG-26-2008 10:43 <br /> <br />From: <br /> <br />To: 17145714209 <br /> <br />Pa'3e:4/4 <br /> <br />POLICY NUMBER: /2 ZDA AG9G 70 <br /> <br />~ <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, <br /> <br />A.DDITIONAT. I ~$UR.c;U - PERSQN-ORUANT?Jl,,'llUN <br /> <br />THE CITY OF S1\NTl\ lUoA. iTS OFPICK'i'~, "GEN'!':::. ;:::MPLOYEES. <br />~EPJ,1:F.~~F.NTATIVES AND VOLlJN'ljo:l-:\oIS <br />'0 C1 Vl (' C'iN1'Bk ;.'l..A7.A <br />fjANTA ANA, CA ;:>701 <br /> <br />7HF. T~r;Tml\NCl:; Ar'~'ORD~~D :n-JD'E:R THlS POJ..J.t:':{ loG PRIMARY ANn <br />NON CONTRIBUTORY 'TO N~Y I)THF.:R INSURANC:F. POLIC'r 1-l.t:.L.U BY TIlE l N~lJRF.n <br /> <br />Form IH 12 DO 11 as T Si:Q. NO. noz Prlntod in U.S.A. Pago (101 <br />Proc;ess Date; OG/1J./oe expiration Oat8: U~/26/09 <br />\lW COPY <br /> <br />FdX frON <br /> <br />118/Z6/88 <br /> <br />111:43 <br /> <br />P9: 4 <br />