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09/29/2010 22:14 FAX Q 003 <br />SH Policy No. 92 -06- 6495 -7 FE•7315.1 <br />(17190) <br />STATE FARM GENERAL INSURANCE COMPANY <br />BLANK ENDORSEMENT <br />This endorsement effective OCT 20 2006 1 the effective hour being the same as that designated in <br />the policy to which this endorsement is attached, forms a part of Policy No. 92-06-6495-7 issued to <br />CHRISTOPH, ANN <br />Loan No. <br />❑ YOUR POLICY IS CHANGED AS FOLLOWS: <br />1 Insured's Name 5 Location <br />2 Insured's Address 6 Construction <br />3 Effective Date 7 Mortgagee or Lienholder's Name <br />4 Expiration Date 8 Mortgagee or Lienholder's Address <br />9 Other (Specify) <br />WAIVER OF CRANSFER RIGHTS OF RECOVERY AGAINST OTHERS <br />NAME OF PERSON OR ORGANIZF,CION: <br />THE CITY OF SANTA ANA, ITS <br />OFFICERS, EMPLOYEES, AGENT';, <br />VOLUNTEERS & REPRESENTATIV13S <br />20 CIVIC CENTER Piz <br />SANTA ANA CA 92701 -4058 <br />We waive any right of recceirery we may have against the person or organization shown above <br />because of payments we mak.:; for injury or damage arising out of your work, as defined in <br />the policy, done under con',ract with that person or organization. The waiver applies <br />only to the person or organization shown above. <br />All other policy provision apply. <br />NO CHANGE IN PREMIUM: <br />CHANGE IN PREMIUM: ❑ INI:' ;REASE ❑ DECREASE <br />ENDORSEMENT PREMIUM: $ <br />FULL TERM PREMIUM FOR ENDORSEMENT; $ <br />'Minimum premium applies. <br />FE- 7315. i <br />(12190) <br />The following Form Numbers are attached to and form a <br />part of your policy. <br />The following Form Numbers are voided and no longer <br />form a part of your policy. <br />Agent <br />Printed in USA <br />